Apply to Takeda Help At Hand Patient Assistance Program
Free Takeda medicines for people with household income up to five times the poverty level who have no or not enough insurance. Apply directly with the program; here is what it asks and what happens next.
Who can apply?
| Household | 1 person | 2 people | 3 people | 4 people |
|---|---|---|---|---|
| Yearly income up to | $79,800 | $108,200 | $136,600 | $165,000 |
Household income at or below 5x the Federal Poverty Level; Alaska and Hawaii differ. Within $1,000 of the limit: call.
For people with no insurance or not enough coverage, and no access to alternate coverage or funding. Medicare patients may be eligible; with Part D and income under 150% FPL, must apply for Extra Help and be denied first (send pre-decisional notice or denial). Medicaid patients may be eligible with a letter of medical necessity (within 90 days) and proof Medicaid denied coverage of the drug. Insured or ACA patients may still be eligible (case by case). Must be treated with a medicine taken at home.
Not for people whose employer or plan sends them to the program as a condition of coverage.
Then what?
Sign
- patient sections 1, 4, 5 and 6 of the application (two patient signatures)
Attach
- proof of income: most recent 1040 tax return (including spouse and dependents 21+), or 1099, SSA benefit statement, W-2, one month of pay stubs within 90 days, or unemployment/workers comp letter
- Extra Help denial if Medicare Part D and under 150% FPL
- Medicaid: letter of medical necessity and proof of Medicaid denial
Your prescriber
- completes prescribing sections and signs
- faxes the application to 1-800-497-0928 (applications are not accepted by email)
Send
- Fax 1-800-497-0928
- Mail to Takeda Help At Hand, P.O. Box 5727, Louisville, KY 40255-0727
Questions: call Takeda Help At Hand Patient Assistance Program at 1-800-830-9159. Up to one year; reapply each year (reminder sent)..
Free. "Takeda does not charge patients a fee for its assistance" and is not affiliated with third parties who charge fees. EveryCard Rx isn't paid by the program and never sends anything for you. Form , rules checked 2026-11-06 from the program's own pages. Something out of date? Tell us.