Drug Information
Drug	Iressa
Generic Equivalent	gefitinib
Topic	Cancer
Program Contact Info / Application Submission
Program	AstraZeneca Foundation (Iressa) Patient Assistance Program
Company	AstraZenIrr
Form	Download PDF
Address	PO Box 66551, St Louis, MO 63166-6551
Phone	800-601-8933
Fax	866-332-4027
Website	http://www.astrazeneca-us.com/content/drugAssistance/
Program Details
Details	A 90-day supply is sent to either the doctor�s office, hospital or pharmacy. Patients or doctors must contact the company for refills. A new application with documentation is needed once a year.
Program Requirements
Information	All signatures must be original, and proof of income must include tax forms as well as current proof.
Details	Insurance card required Drivers license NOT required Proof of Income required Copy of most recent tax return such as 1040, 1099 NOT required as proof of income Letter from Doctor stating zero incomeNOT 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 Most recent check/check stub copy required as proof of income Letter from employer NOT required as proof of income Benefits statement for Social Security, Unemployment, Veterans Benefits, Pension/Retirement required as proof of income Award Letter for Alimony/Child Support, Unemployment required as proof of income Notarized statement from patient stating zero income NOT required as proof of income
Other Requirements	Prescribed medication prior to 9/15/05
Delivery of Medication
Ship Time	48hrs
Delivery Options	Can be delivered directly to the patient Can be delivered directly to the doctor
Application Process
App Process	Anyone requesting assistance can call to request a faxed application or download it from the website. The application will be faxed out. The completed application can be faxed or mailed back. Both the patient and doctor are notified of acceptance into the program. The decision is usually made within 48 hours. The medication is shipped the next day.
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 NOT apply for a new application via phone Can NOT 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 Can NOT apply for refills via fax Can apply for refills via mail
Re-Applications	Re-Applications accepted Patients can apply for Re-Applications Doctors can 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
Appeals	Income Appeals accepted Patients can apply for Income Appeals Doctors can apply for Income Appeals Advocates can apply for Income Appeals Hardship Appeals accepted Patients can apply for Hardship Appeals Doctors can apply for Hardship Appeals Advocates can apply for Hardship Appeals Can NOT apply for an appeal via phone Can NOT apply for an appeal via fax Can apply for an appeal via mail
Eligibility
Eligibility	Patiens must not have prescription coverage and be ineligible for any state or federal programs such as Medicaid. The income requirements are based on 300% of the federal poverty level.
Limitations	Patients are eligible if LIS is denied Patients are NOT eligible with existing prescription coverage Patients are NOT eligible if prescription is not covered Patients are NOT eligible if prescription coverage has been exhausted Patients are eligible if they are accepting Medicare Patients are NOT eligible if they are accepting Medicare part D Patients are eligible if the medication is not covered under Medicare Patients are eligible if Medicare coverage has been exhausted
Appeals
Conditions	Appeals will consider out-of-pocket expenses Appeals will consider total medical expenses Appeals must be made after the patient has been denied
Other Medications
Other  Medications  available in  this program	Iressa - Cancer (Generic: gefitinib)