What forms does one need for vascepa aid?

How to Apply for Vascepa Patient Assistance

Vascepa (icosapent ethyl) patient assistance programs help eligible uninsured or underinsured patients get the drug for free or at low cost. The main program is the Vascepa Savings Card from Amarin Pharma for commercially insured patients, and the Patient Assistance Foundation (PAF) for those without insurance. Forms differ by program.

Vascepa Savings Card Application Process

• No formal "form" needed upfront; prescribers or patients activate it online or by phone.
  
• Doctor provides prescription; patient or pharmacy submits via vascepasavings.com or 1-877-310-6954.
  
• Eligibility: Commercial insurance covering Vascepa, out-of-pocket costs $25–$179/month (max savings $7,200/year).[1]
  
  

Patient Assistance Foundation (PAF) for Uninsured

• Download the PAF application form from pafoundation.org or call 1-866-255-0659.
  
• Key sections: Patient info, household income (≤400–500% FPL), proof of no insurance, prescriber details.
  
• Submit with income docs (tax returns, pay stubs), pharmacy info, and prescription.
  
• Approval grants 3–12 months supply free; renew annually.2
  
  

What Documents to Gather

• Proof of income (W-2s, 1099s, bank statements).
  
• Insurance denial letter or proof of uninsured status.
  
• Prescription from doctor.
  
• Photo ID and Social Security number (for PAF).
  
  

Eligibility Basics Across Programs

| Program | Who Qualifies | Cost After Approval |
|---------|---------------|---------------------|
| Savings Card | Commercial insurance; U.S. resident | $25–$179 copay/month |
| PAF | Uninsured/low-income (≤$60K single/$80K household typical) | Free |

Who Handles Vascepa Assistance?

Amarin Pharma runs the Savings Card; PAN Foundation or similar nonprofits manage broader aid. Check vascepa.com/support or call 1-855-682-7372 for latest forms.[1]

Common Reasons Applications Fail

Income exceeds limits, incomplete docs, or non-U.S. residency. Resubmit within 30 days if denied.

Sources
[1]: vascepa.com/savings-support
[2]: pafoundation.org/apply