Program Contact Info / Application Submission
Program	Prograf Patient Assistance Program
Company	AstelProg
Form	Download PDF
Address	PO Box 13185, La Jolla, CA 92039
Phone	800-477-6472
Fax	866-317-6235
Website	http://www.astellasreimbursement.com/
Program Requirements
Details	Proof of Income required Copy of most recent tax return such as 1040, 1099 required as proof of income
Delivery of Medication
Ship Time	10 business days
Delivery Options	Can be delivered directly to the patient Can be delivered directly to the doctor Shipped as a voucher card
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 NOT apply for a new application via phone 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 Can apply for refills via fax
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 Re-Apply via fax Can Re-Apply via mail
Appeals	Income Appeals NOT accepted Patients can NOT apply for Income Appeals Doctors can NOT apply for Income Appeals Advocates can NOT apply for Income Appeals Hardship Appeals NOT accepted Patients can NOT apply for Hardship Appeals Doctors can NOT apply for Hardship Appeals Advocates can NOT apply for Hardship Appeals Can NOT apply for an appeal via phone
Appeals
Conditions	Appeals will NOT consider out-of-pocket expenses Appeals will NOT consider total medical expenses
Other Medications
Other  Medications  available in  this program	Prograf 0.5mg - immunosuppressant Transplant (Generic: tacrolimus, FK506) Prograf 1mg - immunosuppressant Transplant (Generic: tacrolimus, FK506) Prograf 5mg - immunosuppressant Transplant (Generic: tacrolimus, FK506)