Program Contact Info / Application Submission
Program	Xigris Treatment Support Program
Company	LillyXigris
Phone	877-522-4357
Fax	866-522-2778
Program Details
Details	The amount requested is sent to the hospital
Program Requirements
Information	The hospital contact person must fill out and sign the application. The patient or patient representative must sign the authorization form.
Delivery of Medication
Delivery Options	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 is sent to the hospital. The completed application must be faxed back.
New Applications	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
Eligibility
Eligibility	The patient can have no public or private prescription insurance and have an income at or below 300% of the Federal Poverty Level. This is a hospital replacement program, so the patient must have already received the medication. This is a product replacement program. The health care provider, pharmacist, or social worker must first be enrolled in the program before enrolling patients.
Other Medications
Other  Medications  available in  this program	Xigris - Sepsis (Generic: drotrecogin alfa)