Avycaz Patient Assistance Programs

Avycaz: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Avycaz. Review the information to see if you qualify. The applications are available in Adobe PDF format and should be mailed directly to the provider of the patient assistance program.

If you have any questions, please call the telephone number for the program (not PharmacyChecker.com) or go to the program website.

Looking for a different medication?

Allergan Patient Assistance Program: Medications/Devices

(Program 1 of 1 — Scroll down to see them all)

Provided by: Allergan, Inc.
PO Box 66764 St. Louis, MO 63166
TEL: 844-424-6727
ALT PHONE: 844-424-6727
FAX: 844-708-0036
Languages Spoken:
English
Program Website
Medications
  • Avycaz (ceftazidime/avibactam)
Eligibility Requirements
  • Insurance Status Must have no prescription coverage for needed medication
  • Those with Part D Elibible? Yes, but have been denied or are ineligible for Low Income Subsidy
  • Income Not disclosed
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? The patient must be a US citizen or legal entrant.
Application
  • Obtaining Call or download
  • Receiving Mailed or downloaded from website
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Medications sent if accepted. If denied patient and doctor notified
  • Decision Timeframe Within 4 weeks
Medication
  • Amount/Supply 90 day supply with up to 3 refills, for a total of up to 1 year of medications
  • Sent To Doctor's office
  • Delivery Time Within 4 weeks
  • Refill Proces New prescription every 3 months
  • Limit One year
  • Re-application New application every 12 months
Additional Information
None
Updated August 9, 2018

If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for Avycaz prices here.

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