Motegrity Prescription Assistance Programs

Motegrity: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Motegrity. 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?

Patient Access Network Foundation (PAN)

(Program 1 of 2 — Scroll down to see them all )

Provided by: Patient Access Network Foundation
None
TEL: 866-316-7263
FAX: 866-316-7261
Languages Spoken:
English, Spanish, Others By Translation Service
Program Website
Medications
  • Motegrity tablet (prucalopride tablet)
Eligibility Requirements
  • Insurance Status *See Additional Information section below
  • Those with Part D Elibible? Determined case by case
  • Income Between 400-500% of FPL
  • Diagnosis/Medical Criteria FDA Approved Diagnosis - See Program Website for Details
  • U.S. Residency Required? Must reside and receive treatment in US
Application
  • Obtaining Call or complete online
  • Receiving Complete online or by phone
  • Returning Complete online or by phone
  • Doctor's Action Will be discussed with patient and Doctor after request is received
  • Applicant's Action Call for information or inform doctor that he/she is in need
  • Decision Communicated Patient and Doctor notified in writing
  • Decision Timeframe Within 48 hours
Medication
  • Amount/Supply Not applicable
  • Sent To Patient sent card to be used at pharmacy
  • Delivery Time Once approved; shipped same day
  • Refill Proces Patient presents voucher/card to pharmacy for each refill
  • Limit None
  • Re-application New application every 12 months
Additional Information
*Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance. Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly. Note: All new enrollment is now done electronically or over the phone. Contact program for details.
Updated October 14, 2019

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

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Takeda Patient Assistance Program

(Program 2 of 2 — Scroll down to see them all )

Provided by: Takeda Pharmaceutical
PO Box 5727 Louisville, KY 40255-0727
TEL: 800-830-9159
FAX: 800-497-0928
Languages Spoken:
English, Others By Translation Service
Program Website
Medications
  • Motegrity tablet (prucalopride tablet)
Eligibility Requirements
  • Insurance Status Must have no coverage for the requested medication, be ineligible for federal or state programs
  • Those with Part D Elibible? Yes
  • Income At or below 500% of FPL
  • Diagnosis/Medical Criteria Not specified
  • U.S. Residency Required? The patient must also be a US resident.
Application
  • Obtaining Call or download
  • Receiving Faxed, mailed or downloaded from website
  • Returning The completed application must be faxed or mailed from the doctor's office.
  • Doctor's Action Complete section, sign, attach prescription and include the DEA or state license number
  • Applicant's Action Complete section, sign, attach a copy of proof of income
  • Decision Communicated Patient and Doctor notified of acceptance
  • Decision Timeframe 5-7 business days
Medication
  • Amount/Supply Up to 90 day supply
  • Sent To Doctor's office or patient's home
  • Delivery Time Not specified
  • Refill Proces Not specified
  • Limit Not specified
  • Re-application New application, new documentation yearly
Additional Information
Applicants not approved for enrollment in the program may have the opportunity to seek an exception to the program criteria.
Updated October 11, 2019

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

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