Drug Information
Drug	Aristocort A tablet
Class	corticosteroids
Topic	Steroid
Program Contact Info / Application Submission
Program	Astellas Patient Assistance Program
Company	Astellas
Address	PO Box 220708 Charlotte, NC 28222-0708
Phone	800-477-6472
Fax	866-317-6235
Website	N/A
Program Details
Details	Medication is sent to the doctor�s office. New applications are needed for each refill.
Program Requirements
Information	The doctor must fill out their section and sign the application. Patients must provide financial, insurance, and medical information, but no signature is required.
Details	Proof of Income NOT required Copy of most recent tax return such as 1040, 1099 NOT required as proof of income
Delivery of Medication
Ship Time	10 business days
Delivery Options	Can NOT be delivered directly to the patient Can be delivered directly to the doctor
Application Process
App Process	Doctors, patient, social workers or patient advocates need to call for a prescreening. Applications are sent to the doctor�s office. Completed applications must be mailed back. Decisions are made during the phone screening. Medication is shipped within 10 business days.
New Applications	New applications NOT accepted Patients can NOT apply directly to the program Doctors can NOT apply directly to the program Advocates can NOT apply directly to the program Can NOT apply for a new application via phone Can NOT apply for a new application via fax Can NOT apply for a new application via mail
Refills	Refills NOT accepted Patients can NOT apply for refills Doctors can NOT apply for refills Advocates can apply for refills Can NOT apply for refills via phone Can NOT apply for refills via fax Can apply for refills via mail
Re-Applications	Re-Applications NOT accepted Patients can NOT apply for Re-Applications Doctors can NOT apply for Re-Applications Advocates can apply for Re-Applications Can NOT Re-Apply via phone Can NOT Re-Apply via fax Can Re-Apply via mail
Eligibility
Eligibility	Patients must meet the insurance and income guidelines that are not disclosed. This is a product replacement program. Patients must also be US residents. Patients must be applied into the program within 60 days of their last date of therapy.
Other Medications
Other  Medications  available in  this program	Adenocard injection - Antiarrhythmic Cardio (Generic: adenosine) Adenoscan IV 20ml - Antiarrhythmic Cardio (Generic: ) AmBisome injection - Antifungals (Generic: amphotericin B, lipid-based) Aristocort A tablet - corticosteroids Steroid (Generic: ) Cyclocort cream - corticosteroids Steroid (Generic: amcinonide)