Start by choosing a medicine. You will have the option to select additional medicines later on. All applications are reviewed on a case-by-case basis in accordance with program criteria.
Please choose a product.
Please answer 5 short questions to see if you may qualify.
This information is not collected or retained.
Who is eligible?
If you have been prescribed a Takeda medicine available through the Help at Hand Program, you may be eligible for the program if all of the following conditions apply:
- You are being prescribed a Takeda medicine by a U.S. physician licensed and practicing in the U.S. or its territories
- You are currently living in the United States with a U.S. address or in a U.S. territory; proof of citizenship is not required
- You do not have health insurance coverage, are struggling to pay for medication, or you do not have enough insurance and need help getting your Takeda medicines
-
As of , your annual household income is*
| Equal to or Less Than |
Household Size |
|
1 (only consists of yourself) |
|
2 (you and one other person) |
|
3 (you and two other people) |
|
4 (you and three other people) |
| 5X the Federal Poverty Level |
5 or more
Visit: HHS Poverty Guidelines |
*Annual household incomes may differ in Alaska and Hawaii. Refer to the HHS Poverty Guidelines for more information. Income levels change annually. If you are within $1,000 of a household income, please call Help At Hand to find out more.
- You do not have access to alternate sources of coverage or funding
- You have recently lost your job and are experiencing financial hardship
The following only applies to Takeda Help At Hand Prescription Assistance Program (PAP) medications that are reimbursed under a Medicare Part D prescription drug plan. If you have Medicare and income below 150% of the Federal Poverty Limit (FPL), you may qualify for the “Medicare Part D Extra Help” Program, also known as “Extra Help,” “Low-Income Subsidy” or “LIS”. Patients with Medicare and income below 150% FPL will not be eligible for Takeda Help At Hand PAP unless you have applied and been denied for that Program. Please include a Pre-decisional Notice or denial letter with your PAP enrollment. If your income is above 150% FPL, you do not need to include a denial letter from the “Medicare Part D Extra Help” Program. Extra Help is a Medicare program to help people with limited income and resources pay Medicare drug coverage (Part D) premiums, deductibles, coinsurance, and other costs. For more information visit https://medicare.gov/extrahelp.
According to the information you entered, you may be eligible for financial assistance with your prescription for .
Download the application and follow these steps to submit your Help at Hand enrollment form for your Takeda medicines:
- Complete each section for Patient Information (1, 4, 5, and 6) of the application including two places for patient signatures.
- Attach your current proof of income as outlined in Section 4.
- Have your health care provider complete sections for prescribing information (2 and 3) and provide a signature at the bottom of section 3. Fax or mail the completed application and all documentation to:
Application and attachments must be mailed to Help at Hand by the health care provider.