You may be eligible to receive free LUPRON DEPOT-PED if you:
- Have been prescribed LUPRON DEPOT-PED
- Have limited or no health insurance coverage
- Live in the United States
- Are being treated by a licensed U.S. health care provider on an outpatient basis
If you have insurance, we will review your qualifying financial need based on a combination of your insurance coverage, household income, and out-of-pocket medical expenses during the application process. To help you understand the income guidelines that we use to evaluate qualifying financial need, we’ve provided the table below:
If you would like to apply, you should work with your healthcare provider to submit a program application. To avoid delays, please follow the instructions on the first page and submit all requested information. Please download the application below.
Program eligibility details
If you have employer-provided insurance coverage or have purchased private insurance on your own, you may qualify for assistance with your out-of-pocket expenses. Visit Lupronped.com.
Available to patients with commercial prescription insurance coverage who meet eligibility criteria. Copay assistance program is not available to patients receiving prescription reimbursement under any federal, state, or government-funded insurance programs (for example, Medicare [including Part D], Medicare Advantage, Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs programs) or where prohibited by law. Offer subject to change or discontinuance without notice. Restrictions, including monthly maximums, may apply. This is not health insurance.