| Pharmaceutical Company | Takeda Pharmaceuticals America |
| Program Address | Specialty Distribution Services Attention: PAP - TAK Customer Service PO Box 66552 St. Louis, MO 63166 |
| Toll Free Phone Number | 877-825-3327 |
| Fax Number | 800-497-0928 |
| Guidelines and Notes | Income guidelines based on poverty; patient's household must be under 300% of federal poverty guidelines. Patient must be a legal US Citizen with no prescription coverage and not be eligible for Medicaid. Actos is the only product covered; Takeda co-markets the drug with Lilly, but this is not Lilly's program. The most recent application says 12/22/00 in the bottom left hand corner. |
| Initiating Enrollment | Will fax application to medical personnel; it can be copied or downloaded. |
| Health Provider's Role | Doctor completes practitioner information, signs and dates it, and writes a prescription for 90 day supply. The application and prescription must be faxed to the program's processing center with an office cover sheet or banner printout, or it can be mailed. |
| Patient's Role | Patient completes information on income and insurance and signs and dates the form. |
| How Dispensed | Eligibility approved within 48 hours. Initial 90 day supply and mailer for refill is sent to patient by Fedex. |
| Amount Dispensed | 90 day supply |
| Refills | Program will continue to provide mailers for a year, then patient must enroll again. |
| Limit | Indefinitely |