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Program Details

SHIRE PHARMACEUTICALS
Shire Cares Patient Assistance & Support

Vyvanse (lisdexamfetamine dimesylate capsules)
 
CONTACT INFO
Address: 6900 College Boulevard Suite 1000
Overland Park, KS 66211
Phone: 1-888-227-3755 Provider Phone:
Fax: 1-877-922-7379 Website: Program Website
ELIGIBILITY
Eligibility Info:
  • The type and level of assistance available varies based on the product, household income and insurance status.
  • Applications are reviewed on a case by case basis.
  • Income at or below: Single $34,470 % FPL
      Couple $46,530 % FPL
    Federal Poverty Level Calculator Federal Poverty Level Calculator
    Other Income Requirements: Income amounts shown are general guidelines.
    Medical expenses can be deducted from reported income: Not Published
    Social security requested on form: Yes
    US citizenship/residency specified: Not Published
    APPLICATION
    Attachments Required: Financial
    Physician License #
    Required:
    DEA
    Prescriber Signature
    Allowed:
    Physician
    Application may be
    faxed:
    Yes
    Eligibility determination
    letter sent:
    MEDICATION
    Receives: Medication
    For Vyvanse a pharmacy card is provided.
    Shipped To: Provider
    Quantity in Shipment: 90 days
    Delivery Time: Not Published
    Re-application Policy: New application every 12 months
    Refill Policy: Not Published
    Other Information:

    Last Updated: 06/03/2013

     

     

     


    Application Forms
    & Instructions

    The following documents are provided in interactive PDF format, allowing you to type information directly into the form.


    DocumentForm (English)


    Document Instructions (English)



     

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