Contact info
- Phone
- 1-855-898-2634
- Fax
- 1-855-982-6341
- Mailing address
- PO Box 13185La Jolla, CA 92039
Eligibility
- Patients must not have insurance or is rendered uninsured.
- Assistance may be available for those with Medicare and Medicare Part D.
- Income limit, single
- Not published
- Income limit, couple
- Not published
- Medical expenses can be deducted
- Not published
- Social Security number asked for
- Yes
- US citizenship or residency required
- Yes
Not sure where your income falls? See this year's federal poverty guidelines (opens in a new tab).
Application process
- Documents to attach
- Proof of income
- Prescriber license number
- NPI number
- State license number
- Who can sign
- Physician
- Application can be faxed
- Yes
- Decision letter sent to
- Provider and patient
Getting the medication
- Patient receives
- Medication
- Shipped to
- Patient
- Supply per shipment
- 30-day supply
- Time to first delivery
- Not published
- Refills
- Not published
- Staying enrolled
- Program will contact patient about re-applying.
More from the program
This program also provides copay assistance.
Medications covered
- Xtandi (enzalutamide)