rxhelp360.org
| Drug Information | ||||||||||||||||||||||||||||||||||||||
| Drug | Duetact tablets 30-2mg | |||||||||||||||||||||||||||||||||||||
| Topic | Diabetic | |||||||||||||||||||||||||||||||||||||
| Program Contact Info / Application Submission | ||||||||||||||||||||||||||||||||||||||
| Program | Takeda Patient Assistance Program | |||||||||||||||||||||||||||||||||||||
| Company | Takeda | |||||||||||||||||||||||||||||||||||||
| Form | Download PDF | |||||||||||||||||||||||||||||||||||||
| Address | PO Box 5727, Louisville, Kentucky 40255-0727 | |||||||||||||||||||||||||||||||||||||
| Phone | 800-830-9159 | |||||||||||||||||||||||||||||||||||||
| Fax | 800-497-0928 | |||||||||||||||||||||||||||||||||||||
| Website | http://www.tpna.com/patasstProgram.asp | |||||||||||||||||||||||||||||||||||||
| Program Requirements | ||||||||||||||||||||||||||||||||||||||
| Details | Insurance card required Drivers license required Proof of Income required Copy of most recent tax return such as 1040, 1099 required as proof of income Form 4506T (If taxes were not filed) required as proof of income Most recent bank statements required as proof of income | |||||||||||||||||||||||||||||||||||||
| Other Requirements | ||||||||||||||||||||||||||||||||||||||
| Delivery of Medication | ||||||||||||||||||||||||||||||||||||||
| Ship Time | 5-7 business days | |||||||||||||||||||||||||||||||||||||
| Delivery Options | Can be delivered directly to the patient Can be delivered directly to the doctor | |||||||||||||||||||||||||||||||||||||
| Application Process | ||||||||||||||||||||||||||||||||||||||
| New Applications | New applications accepted Patients can apply directly to the program Doctors can apply directly to the program Advocates can apply directly to the program Can apply for a new application via fax Can apply for a new application via mail | |||||||||||||||||||||||||||||||||||||
| Refills | Refills accepted Patients can apply for refills Doctors can apply for refills Advocates can apply for refills Can apply for refills via phone | |||||||||||||||||||||||||||||||||||||
| Re-Applications | Re-Applications accepted Patients can 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 NOT Re-Apply via mail | |||||||||||||||||||||||||||||||||||||
| Appeals | Income Appeals accepted Patients can apply for Income Appeals Doctors can NOT apply for Income Appeals Advocates can apply for Income Appeals Hardship Appeals NOT accepted Patients can NOT apply for Hardship Appeals Doctors can NOT apply for Hardship Appeals Advocates can apply for Hardship Appeals Can apply for an appeal via phone Can NOT apply for an appeal via fax Can NOT apply for an appeal via mail | |||||||||||||||||||||||||||||||||||||
| Eligibility | ||||||||||||||||||||||||||||||||||||||
| Limitations | Patients may be eligible if LIS is denied on a case by case basis Patients are eligible with existing prescription coverage Patients are NOT eligible if they are accepting Medicare Patients are eligible if they are accepting Medicare part D | |||||||||||||||||||||||||||||||||||||
| Other Medications | ||||||||||||||||||||||||||||||||||||||
| Other Medications available in this program |
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