The Amevive LoyaltyScript Card Program offers assistance with your pharmacy out-of-pocket costs for Amevive.
- Each insured patient who is eligible for the program will pay approximately $20 pharmacy co-pay for a single injection of Amevive†
- Benefits apply for up to 2 courses (24 vials) of Amevive within 1 year and is not renewable
- Enrollment is easy and there is no cost to enroll
- Patients who are commercially insured (not on Medicare, Medicaid, Medigap, or other state or federal government insurance)
- Patients who reside in the 50 states or Puerto Rico, excluding Massachusetts
- Patients who are 18 years or older
- Patients who receive Amevive through a retail or specialty pharmacy
- Patients who are cash payers
- Talk to a Astellas Reimbursement Specialist at 1-866-263-8483 to see if you are eligible
- Your physician or their office staff can assist in the enrollment process
Want to learn more?
Call one of our reimbursement specialists at Astellas Reimbursement ServicesSM or visit
www.astellasreimbursement.com for more information
about the Amevive LoyaltyScript Card Program and to see if you are eligible.
†The maximum benefit per injection is $200. If your out-of-pocket cost exceeds $220, you will be required to pay the overage.
The maximum annual benefit per patient is $4,800 or $200 per vial.
This program is limited to one card per patient and is not renewable.