Promacta Prescription Assistance Programs

Promacta: Apply for prescription assistance below

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

Novartis Patient Assistance Foundation, Inc.

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

Provided by: Novartis Pharmaceuticals Corporation
PO Box 52029 Phoenix, AZ 85072-2029
TEL: 800-277-2254
FAX: 855-817-2711
Languages Spoken:
English, Others By Translation Service
Program Website
  • Promacta (eltrombopag)
Eligibility Requirements
  • Insurance Status Contact program for details.
  • Those with Part D Elibible? Contact program for details.
  • Income At or below 600% of FPL
  • Diagnosis/Medical Criteria Not specified
  • U.S. Residency Required? The patient must reside in the US, Puerto Rico or the USVI.
  • Obtaining Call or download
  • Receiving Faxed
  • Returning The completed application can be faxed or mailed back.
  • Doctor's Action Complete section, sign, attach prescription for 90 days
  • Applicant's Action Complete section, sign, attach proof of income
  • Decision Communicated Doctor notified via mailed letter
  • Decision Timeframe Not specified
  • Amount/Supply Varies
  • Sent To Patient's home, unless otherwise noted
  • Delivery Time Not specified
  • Refill Proces Patient must contact company
  • Limit Not specified
  • Re-application New application, new documentation yearly
Additional Information
For Focalin XR, Clozaril, and Ritalin LA, Clozarila pharmacy card will be issued. All other medication will be shipped directly to the patient, unless otherwise noted. *Additional products may be available. Please contact the program for a complete product listing.
Updated November 21, 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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