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prograf patient assistance program form

by Daryl Johnston Published 2 years ago Updated 1 year ago
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How do you qualify for Prograf patient assistance?

Eligibility. The Prograf Patient Assistance Program is designed to assist patients who have no health insurance and limited financial resources. To be eligible for the program, patients must meet income, residency and insurance criteria. If the patient meets the criteria, hotline staff will send a pre-filled application to the physician.

How do I enroll patients in the Prograf â„¢ program?

To enroll a patient, physicians must first register with the program. Registered physicians may enroll patients by submitting a patient enrollment form and a prescription. If approved, the patient will receive two 90-day shipments of Prograf â„¢ from a mailorder pharmacy affiliated with the program.

Where can I find more information about Prograf?

The Patient Information summarizes the most important information about PROGRAF. If you would like more information, talk with your healthcare provider. You can ask your pharmacist or healthcare provider for information about PROGRAF that is written for health professionals. What is PROGRAF?

How do I apply for a copay assistance program?

Click drug logo or drug name to start online application. This is a copay assistance program for patients that have health insurance. The patient's insurance must cover the qualifying medication that they are seeking assistance for. Patient with Medicare Part D will be considered on a case by case basis.

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How can I get help paying for tacrolimus?

The Prograf Patient Assistance Program is designed to assist patients who have no health insurance and limited financial resources. To be eligible for the program, patients must meet income, residency and insurance criteria.

Is Prograf covered by Medicare?

Yes. 100% of Medicare prescription drug plans cover this drug.

Does Prograf cause memory loss?

In 100 people receiving Tacrolimus, from 4 to 20 may have: Damage to organs (heart, lungs, brain, others) which may cause changes in thinking, confusion, memory loss or shortness of breath. Allergic reaction which may cause rash, low blood pressure, wheezing, shortness of breath, swelling of the face or throat.

How long does Prograf stay in your system?

The drug's mechanism of action is to lower your immune system's response and prevent your body from rejecting a transplanted organ. The half-life of tacrolimus is about 2 days. This means that half of a dose of tacrolimus is removed from your body after 2 days.

What is the retail price of Prograf?

About Prograf The lowest GoodRx price for the most common version of generic Prograf is around $68.76, 81% off the average retail price of $369.56. Compare CNI immunosuppressants.

What drug tier is Prograf?

What drug tier is tacrolimus typically on? Medicare prescription drug plans typically list tacrolimus on Tier 2 of their formulary. Generally, the higher the tier, the more you have to pay for the medication.

Which foods increase tacrolimus levels?

Avoid excessive intake of high potassium foods (bananas, oranges, orange juice, potatoes, spinach, etc). Do not eat grapefruits, grapefruit juice or any soda (Fresca) or fruit juice blend that contains grapefruit juice. Grapefruit can increase your levels of tacrolimus to a potentially toxic level.

What are the long term side effects of Prograf?

nervous system problems.headache.changes in behavior.confusion.coma.seizures.tremors.changes in your vision.numbness and tingling.

What are the long term side effects of tacrolimus?

This medicine may cause serious brain or nerve problems (eg, posterior reversible encephalopathy syndrome). Tell your doctor right away if you have blurred vision, confusion, dizziness, headache, mental changes, seizures, high blood pressure, unusual drowsiness, tiredness, or weakness, or a fast heartbeat.

What fruits should transplant patients avoid?

Most foods and drinks are completely safe for you to take after transplant. Please AVOID grapefruit, pomegranate, pomelo, blood orange, and black licorice, as these can increase the amount of anti- rejection medication in your body and this could harm you.

What happens when your Prograf level is high?

high potassium level--nausea, weakness, chest pain, irregular heartbeats, loss of movement; kidney problems--swelling, urinating less, feeling tired or short of breath; low magnesium or phosphate--bone pain, jerky muscle movements, muscle weakness or limp feeling, slow reflexes; or.

How does tacrolimus affect the brain?

The neurological side effects of calcineurin inhibitors (cyclosporine and tacrolimus) are most commonly mild, such as headache, dysarthria, visual changes, and postural tremor [2]. Severe side effects can include psychosis, cortical blindness, and seizures [2].

Does Medicare Part B cover immunosuppressive drugs?

Under certain conditions, Part B also covers: Bone marrow and cornea transplants. Cornea transplants. Immunosuppressive (or “transplant”) drugs associated with Medicare-covered transplants.

Does Medicare Part B pay for transplant drugs?

Part B will only cover your transplant drugs after you're enrolled in Part B. There won't be any retroactive coverage. Beginning January 1, 2023, Medicare will offer a new benefit that helps continue to pay for your immunosuppressive drugs beyond 36 months, if you don't have other health coverage.

What is the generic for Prograf?

Introduction. If you've had an organ transplant or if you have eczema, you may want to learn more about tacrolimus (Astagraf XL, Envarsus XR, Prograf, Protopic). Tacrolimus is a generic prescription drug that comes as a liquid for injection, a capsule, and an ointment.

Is there a generic for Prograf?

On August 25, 2017, the FDA approved an AP-rated generic version of Astellas' Prograf (tacrolimus) 5 mg/mL injection. Prograf is approved for the prophylaxis of organ rejection in patients receiving allogeneic kidney, heart, or liver transplants.

Important Note

The following information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist or other healthcare professional. It should not be construed to indicate that use of the drug is safe, appropriate, or effective for you. Consult your healthcare professional before using this drug.

Uses

Tacrolimus is used to prevent the body from rejecting a transplanted organ.

Uses

This medication may also be used for other purposes as determined by your doctor.

How To Use

Take this medication by mouth exactly as prescribed, usually every 12 hours. It is best taken on an empty stomach 1 hour before or 2 hours after a meal. If stomach upset occurs, you may take this medication with food; however, this may decrease the amount of tacrolimus absorbed into your bloodstream.

Side Effects

Tremor, headache, diarrhea, nausea, increased blood pressure, trouble sleeping or tingling of the hands or feet may occur. If any of these effects persist or worsen, notify your doctor promptly.

Precautions

Tell your doctor if you have: kidney disease, liver disease, high blood pressure, diabetes, any allergies. This medication is not recommended for use if you have the following medical conditions: heart disease (e.g., QT prolongation). This medication is not recommended for use during pregnancy or while breast-feeding.

Drug Interactions

Tell your doctor of all over-the-counter or prescription medications you may use, including: cyclosporine, cimetidine, bromocriptine, heart medications (e.g., nifedipine), vaccines, "statin" drugs for high cholesterol, anti-seizure medicines, nefazodone, azole antifungals (e.g., ketoconazole, itraconazole), macrolide antibiotics (e.g., erythromycin, clarithromycin), rifamycins (e.g., rifampin, rifabutin), St.

What is Prograf injection?

Prograf has been approved by the FDA to lower your body's immune system, allowing for an organ transplant to have less risk of rejection. Prograf is administered as an injection or in capsule form.

How to enroll in Astellas?

Fill out the program enrollment form located to your right. If you don't see an enrollment form available please call Astellas program directly. After filling out the enrollment form please bring the form to your doctor for proper signatures and procedures. Do not forget a self stamped envelope for them to mail in your application to the program.

When was Astellas Pharma founded?

Astellas Pharma Inc. was establish in Japan on April 1st, 2005. Astellas Pharma Inc. formed through the merger of Yamanouchi Pharmaceutical Co., Ltd. (founded in Osaka, Japan, 1923) and FujisawaPharmaceutical Co., Ltd. (founded in Osaka, Japan, 1894). As a new pharmaceutical company, Astellas Pharma Inc. aims to develop innovative and useful pharmaceuticals on a worldwide scale. Their parent companies reputations of quality and reliability has carried over into the newly formed Astellas Pharma Inc., giving them a solid reputation to build their treatments and therapies on.

How many Americans can't afford medication?

There are over 100 million Americans that either can‚t afford their medication or are struggling to afford their medication. We aim to help each and every American in that situation.

Does Astellas offer Prograf?

Astellas Patient Assistance Program For Organ Transplant , a patient assistance program provided by Astellas Pharma Inc., offers Prograf at no cost to those who are eligible for the program. Eligibility is based off of the following requirements:

Do you have to be a citizen of the United States?

You must be a citizen of the United States or its Territories.

What is the number for Medicare Part D?

Phone : (866)316-7263. Fax: (866)316-7263. Eligibility. >. This is a copay assistance program for patients that have health insurance. The patient's insurance must cover the qualifying medication that they are seeking assistance for. Patient with Medicare Part D will be considered on a case by case basis.

What information do you need to apply for a transplant?

The person who starts the process needs to have patient's diagnosis/transplant information, insurance information, health care provider information, and transplant doctor's name and phone number.

What is the fax number for Medicare?

Fax: 866-317-6235. Eligibility. >. The patient must meet income and insurance guidelines that are not disclosed. Patients with Medicare and Medicare Part D that are in the donut hole may qualify for assistance. Who Can Apply.

What is the number for Prograf?

Fax: (703) 968-2909. Eligibility. >. The Prograf Patient Assistance Program is designed to assist patients who have no health insurance and limited financial resources. To be eligible for the program, patients must meet income, residency and insurance criteria.

What is the poverty level for Medicare Part D?

Patient with Medicare Part D will be considered on a case by case basis. Patients must be at or below 400-500% of the federal poverty level, must have a medically appropriate diagnosis/condition and must reside and receive treatment in the US. Who Can Apply. >.

What do you need to sign a prescription?

The doctor needs to sign the application and provide patient prescription information.The patient needs to sign the application and provide proof of income, expenses and asset information.

Do you have to call for information from a doctor?

Patients must call for information or inform their doctor that they are in need. Doctors action will be discussed with the patient and doctor after the request is received.

How to reorder Novo Nordisk?

You will receive a reorder reminder from Novo Nordisk before your patient is due for a refill. You will need to place a reorder during the calendar year for which your patient has been approved to receive medicine. Reorders can be requested by completing and submitting the Refill Request Form below or by calling Novo Nordisk toll-free at 1-866-310-7549.

What is a PAP in Novo Nordisk?

The Novo Nordisk Patient Assistance Program (PAP) is based on our commitment to people living with diabetes. The Novo Nordisk PAP provides medication at no cost to those who qualify. There is no registration charge or monthly fee for participating.

What proof do you need to get Medicare Part D?

Patients who are eligible for Medicare Part D must provide proof of Medicaid or Extra Help/LIS denial

When will Novo Nordisk give free insulin?

If approved, your patient will receive a free 90-day supply of insulin. Novo Nordisk will check back with them (before their 90-day enrollment ends) to determine continued eligibility. Assistance can be extended to the end of 2020 for otherwise eligible patients who have been denied Medicaid coverage.

How long is a Medicare approved application valid?

Patients can renew each year for as long as they qualify. For uninsured patients, an approved application is valid for 12 months. For patients with Medicare Part D coverage, an approved application is valid for the benefit year only. Some restrictions may apply.

Where to mail Novo Nordisk application?

Fax the completed application and proof of income to 1-866-441-4190, or mail them to Novo Nordisk Inc., PO Box 370, Somerville, NJ 08876. (Important: Faxes must be sent from your office.)

What are the eligibility requirements for NeedyMeds?

Eligibility requirements: Patient must be a US citizen or legal resident. Total household income must be at or below 400% of the federal poverty level (FPL). Visit the NeedyMeds website, which lists the current FPL guidelines. Patient has no insurance or has Medicare.

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Important Note

  • The following information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist or other healthcare professional. It should not be construed to indicate that use of the drug is safe, appropriate, or effective for you. Consult your healthcare professional before using this drug. TACROLIMUS - ORAL (ta...
See more on patientassistance.com

How to Use

  • Take this medication by mouth exactly as prescribed, usually every 12 hours. It is best taken on an empty stomach 1 hour before or 2 hours after a meal. If stomach upset occurs, you may take this medication with food; however, this may decrease the amount of tacrolimus absorbed into your bloodstream. If you take this on an empty stomach, always take it on an empty stomach. If you t…
See more on patientassistance.com

Side Effects

  • Tremor, headache, diarrhea, nausea, increased blood pressure, trouble sleeping or tingling of the hands or feet may occur. If any of these effects persist or worsen, notify your doctor promptly. Notify your doctor promptly if you develop: vomiting, dizziness, anxiety, fever, chills, weakness, vision changes, chest pain, easy bruising or bleeding, swelling of the feet or ankles. Tell your doc…
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Precautions

  • Tell your doctor if you have: kidney disease, liver disease, high blood pressure, diabetes, any allergies. This medication is not recommended for use if you have the following medical conditions: heart disease (e.g., QT prolongation). This medication is not recommended for use during pregnancy or while breast-feeding. Discuss the risks and benefits with your doctor.
See more on patientassistance.com

Drug Interactions

  • Tell your doctor of all over-the-counter or prescription medications you may use, including: cyclosporine, cimetidine, bromocriptine, heart medications (e.g., nifedipine), vaccines, "statin" drugs for high cholesterol, anti-seizure medicines, nefazodone, azole antifungals (e.g., ketoconazole, itraconazole), macrolide antibiotics (e.g., erythromycin, clarithromycin), rifamycin…
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Overdose

  • If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include chest pain, hand tremors, or decrease in amount of urine.
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Notes

  • Laboratory tests will be done frequently while taking this medication to monitor the effects and prevent side effects.
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Missed Dose

  • Take this medication as directed. If you miss a dose, take it as soon as remembered; do not take it if it is near the time for the next dose, instead, skip the missed dose and resume your usual dosing schedule. Do not "double-up" the dose to catch up.
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Storage

  • Store this medication at room temperature between 59 and 86 degrees F (15 to 30 degrees C) away from heat and light. Do not store in the bathroom. Keep this and all medications out of the reach of children.
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Medical Alert

  • Your condition can cause complications in a medical emergency. For enrollment information call MedicAlert at 1-800-854-1166 (USA), or 1-800-668-1507 (Canada).
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