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      Patient Assistance Program Center

Program Details

Shire Cares Patient Assistance & Support

Vyvanse (lisdexamfetamine dimesylate capsules)
Address: P.O. Box 5666
Louisville, KY 40255-0666
Phone: 1-888-227-3755 Provider Phone:
Fax: 1-877-922-7379 Website: Program Website
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.
  • Patients with Medicare Part D may be eligible.
  • Income at or below: Single 300 % FPL
      Couple 300 % FPL
    Federal Poverty Level Calculator Federal Poverty Level Calculator
    Medical expenses can be deducted from reported income: Not Published
    Social security requested on form: Yes
    US citizenship/residency specified: Yes
    Attachments Required: Financial
    Physician License #
    Prescriber Signature
    Application may be
    Eligibility determination
    letter sent:
    Receives: Medication
    For Mydayis and 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: 08/31/2017




    Application Forms
    & Instructions

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

    DocumentForm (English)


    Print-friendly version

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