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 or go to the program website.

Looking for a different medication?

Shire Cares

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

Provided by: Takeda Pharmaceuticals America, Inc.
Shire Cares Patient Assistance & Support Program PO Box 5666 Louisville, KY 40255-0666
TEL: 888-227-3755
FAX: 877-922-7379
Languages Spoken:
English, Others By Translation Service
Program Website
Program Applications and Forms
  • Motegrity (prucalopride)
Eligibility Requirements
  • Insurance Status Determined case by case
  • Those with Part D Elibible? Yes
  • Income At or below 500% of FPL
  • Diagnosis/Medical Criteria FDA-approved diagnosis
  • U.S. Residency Required? The patient must be a US citizen or legal entrant.
  • Obtaining Call or download
  • Receiving Faxed, mailed or downloaded from website
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section and sign
  • Applicant's Action Complete section, sign, attach proof of income and any insurance information
  • Decision Communicated Patient and Doctor notified in writing
  • Decision Timeframe 2-4 business days
  • Amount/Supply 90 day supply
  • Sent To Patient sent card to be used at pharmacy
  • Delivery Time Not specified
  • Refill Proces Not specified
  • Limit Not specified
  • Re-application New application yearly
Additional Information
Each Application will be considered on a case by case basis.
Updated May 9, 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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