Xigris Treatment Support Program - Patient Assistance Programs

Summary

Eli Lilly & Company was established in 1876 by Colonel Eli Lilly, a pharmaceutical chemist and veteran of the U.S. Civil War. In the 130 years since the founding of this company, Eli Lilly & Company have launched over 15 different medications to 143 different countries.

The state of the art technology that they utilize, along with the various experts involved in their research and development, has provided Eli Lilly & Company an impressive portfolio of first class pharmaceutical products.

Xigris is a recombinant version of human Activated Protein C launched by Eli Lilly & Company in 2001. Xigris has been approved by the FDA to treat cases of Sepsis by decreasing inflammation and coagulation, while increasing fibrinolysis in microvascular function. Xigris is taken through injection.

Eligibility

Xigris Treatment Support Program, a patient assistance program provided by Eli Lilly & Company, offers Xigris 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 any private, public, or Medicare Part D prescription coverage programs.

You must have already received the medication, as this is a hospital replacement program.

Your income must be less than or equal to 300% of the Federal Poverty Guideline for the size of your household (see chart below).

SOURCE: 2008 Poverty Chart

Family Size

300%

250%

200%

150%

133%

100%

$32,490

$27,075

$21,660

$16,245

$14,404

$10,830

$43,710

$36,425

$29,140

$21,855

$19,378

$14,570

$54,930

$45,775

$36,620

$27,465

$24,352

$18,310

$66,150

$55,125

$44,100

$33,075

$29,327

$22,050

$77,370

$64,475

$51,580

$38,685

$34,301

$25,790

$88,590

$73,825

$59,060

$44,295

$39,275

$29,530

$99,810

$83,175

$66,540

$49,905

$44,249

$33,270

$111,030

$92,525

$74,020

$55,515

$49,223

$37,010

Each Additional Family Member

$11,220

$9,350

$7,480

$5,610

$4,974

$3,740

What´s Next?

Fill out the program enrollment form located to your right. If you don't see an enrollment form available please call Eli Lilly & Company 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 Eli Lilly & Company 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 AAI Pharma Inc. program. Without their help millions of people will be without medication.