| Pharmaceutical Company | Shire US Inc |
| Program Address | Shire US Patient Assistance Program PO Box 698 Somerville NJ 08876 |
| Toll Free Phone Number | no toll free number |
| Alternate Phone Number | 908-203-0657 |
| Fax Number | n/a |
| Guidelines and Notes | Patients with no prescription drug coverage, or prescription coverage exhausted and meets income guidelines. Income guidelines depend on the drug requested. If patient has run out of prescription coverage they will need to get a letter stating so from their insurance company. If patient has Medicare only, they will need to provide a copy of their Medicare card and a written statement saying they have no prescription coverage. Company also has a cost-share program for patients who don't meet the eligibility guidelines for assistance. |
| Initiating Enrollment | Only doctors office can call. Provide information about doctor and patient including address where patient will be seen and patient's demographic. |
| Health Provider's Role | Doctor completes, signs, and ATTACHES RX. |
| Patient's Role | If there is insurance, provide statement that they have met their max allowed for the year for drug from company. If on Medicare, provide copy of card and signed statement certifying there is no drug coverage. Proof of pt./household income required. PATIENT SIGNATURE REQUIRED. |
| How Dispensed | Sends medicine to doctor's office where patient will be seen. |
| Amount Dispensed | 90 day supply |
| Refills | Physician obtains reorder form that must be signed by physician and patient, attaches new prescription, and mails in.. |
| Limit | Indefinitely |