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Estimated Patient Savings $2,353,450
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Keppra Patient Assistance Program


Summary

UCB Pharma is currently a world leader in antibody research, with over thirty major research and development partners. Their operations span over forty countries, and netted over $3 billion in 2007 alone. UCB Pharma has twelve prospects in the development pipeline which may be used to treat diseases such as Crohn’s disease, Parkinson’s disease, and multiple sclerosis. With a staff of more than ten thousand globally, UCB Pharma is able to successfully and in a timely manner, treat their patients who are afflicted with what they call “silent diseases” such as Crohn’s and Parkinson’s.

Keppra is an anti-epilleptic launched by UCB Pharma in 2006. Keppra has been approved by the FDA to treat partial-onset seizures in adults. Keppra is administered orally via a tablet, or solution.

Eligibility

Keppra Patient Assistance Program, a patient assistance program provided by UCB Pharma, offers a six month supply of Keppra at no cost to those who are eligible for the program. Eligibility is based off of the following requirements:

- You must not be covered by private or public health insurance.

- Your annual income must be no greater than $15,000 if single, but no greater than $25,000 for a couple or single with dependents.

- You must be diagnosed with epilepsy.

- You must be a citizen of the United States or its Territories.

The medication must be sent to the physicians office.

Those eligible for Medicare Part D but not enrolled may still be eligible.

SOURCE: 2008 Poverty Chart
Family Size 100% 133% 150% 200% 250% 300%
1 $10,830 $14,404 $16,245 $21,660 $27,075 $32,490
2 $14,570 $19,378 $21,855 $29,140 $36,425 $43,710
3 $18,310 $24,352 $27,465 $36,620 $45,775 $54,930
4 $22,050 $29,327 $33,075 $44,100 $55,125 $66,150
5 $25,790 $34,301 $38,685 $51,580 $64,475 $77,370
6 $29,530 $39,275 $44,295 $59,060 $73,825 $88,590
7 $33,270 $44,249 $49,905 $66,540 $83,175 $99,810
8 $37,010 $49,223 $55,515 $74,020 $92,525 $111,030
For each additional family member $3,740 $4,974 $5,610 $7,480 $9,350 $11,220


What´s Next?

Fill out the program enrollment form located to your right. If you don’t see an enrollment form available please call UCB Pharma program directly. After filling out the enrollment form please bring the form to your doctor for proper signatures and procedures. Do not forget a self stamped envelope for them to mail in your application to the program.


Other Tips

  • If you have any questions please call the UCB Pharma program directly
  • Fill out as much of the information on the enrollment form as possible. The more information you have pre-filled the easier the progrm is to enroll in
  • Write down the refill dates for your program and set a reminder here on PatientAssistance.com so that you don’t run out of medication.
  • Do not write messy on your forms as this will delay any response
  • Call and write thank you notes to UCB Pharma program. Without their help millions of people will be without medication.




  • PAP Links:
  • Website:
  • Address:
  • Phone:
  • Fax:
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List of Medications
Keppra Oral Solution 100mg/ml (levetiracetam), Keppra Tablets 250mg, 500mg, 750mg, 1000mg (levetiracetam), Keppra XR Tablets 500mg (levetiracetam)

Forms and other information are Copyright © Keppra Patient Assistance Program

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