Free Product for Takeda Help At Hand is available for those applicants meeting all program eligibility requirements and whose health care provider has prescribed a Takeda product. Follow the eligibility requirements.

Application Checklist

checklist application image

Follow the checklist to complete the application along with your doctor. Be sure to include all supporting documents and submit.


If you are eligible, click on the application to obtain the PDF or call 1-800-830-9159 to have a physical copy of the application mailed/faxed to your physician’s office or to your home.

application image

The application can be faxed from your health care provider to 1-800-497-0928 or mailed to
Takeda Patient Assistance Program
P.O. Box 5727, Louisville, KY 40255-0727
Phone: 1-800-830-9159
Fax: 1-800-497-0928

Next Steps

Once your application has been submitted, we will start the review process which may take up to 3-5 business days. We encourage you to submit a complete application as incomplete applications result in processing delays. You will receive a letter indicating the eligibility decision.


  • A letter will be mailed to you to inform you how you will receive your medication from the program. Your prescriber will also receive a similar letter via fax.
  • Our pharmacy will ship the prescribed medication directly to the address indicated on the application.

Missing Information

  • If any information is missing or illegible, you and your health care provider will receive a notification letter (fax or mail).
  • If the missing information is obtained successfully, all new documentation and information will be reviewed.
  • After three unsuccessful attempts to reach you and your HCP, a denial decision is made.


You will receive a denial letter if it was determined that your application did not meet the eligibility criteria. You may appeal this decision within 90 days of the processing date or reapply after the 90-day period.

Re-Enrollment in the Program

Once approved, you’ll receive your prescribed and approved medicines for up to one year, but you will need to re-apply in advance of your program eligibility end date if you continue to need help. Before your enrollment ends, we’ll send you a reminder to renew your application.