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  • Contact Contact
    • For help with VEOZAH,
      please call 1-866-239-1637.

      For help with XOSPATA,
      please call 1-844-632-9272.

      For help with XTANDI,
      please call 1-855-898-2634.

      For help with PADCEV,
      please call 1-888-402-0627.

      For help with CRESEMBA,
      please call 1-800-477-6472.

  • Prescriber Portal Prescriber Portal
    • Use the Prescriber Portal to enroll your
      patients and/or check the status of their claim.

  • Patient Portal Patient Portal
    • Visit the Patient Portal
      to help you understand your
      coverage and reimbursement
      options when prescribed
      an Astellas medication.

  • Important Safety Information
  • Full Prescribing Information, Including Boxed Warning
  • XOSPATAHCP.com
  • Patient Enrollment Process
  • Benefits Verification
  • Prior Authorization
    • Prior Authorization Denial Appeals
  • QUICK START+®
  • Forms and Documents
  • Patient Assistance
    • XOSPATA Patient Savings Program
    • Astellas Patient Assistance Program
  • Additional Patient and Caregiver Support
  • Pharmacies and Distributors
    • Specialty Pharmacies
    • Specialty Distributors
  • XOSPATAHCP.com

Menu

  • Patient Enrollment Process
  • Benefits Verification
  • Prior Authorization
    • Prior Authorization
      • Prior Authorization Denial Appeals
  • QUICK START+®
  • Forms and Documents
  • Patient Assistance
    • Patient Assistance
      • XOSPATA Patient Savings Program
      • Astellas Patient Assistance Program
  • Additional Patient and Caregiver Support
  • Pharmacies and Distributors
    • Pharmacies and Distributors
      • Specialty Pharmacies

Forms and Documents

  • XOSPATA Support SolutionsSM Patient Enrollment Form
    (PDF - 204 KB)
  • Sample Letter of Medical Necessity
    (PDF - 158 KB)
  • Sample Letter of Denial Appeal
    (PDF - 108 KB)
  • Patient Authorization Form
    (PDF - 244 KB)
  • Medicare Extra Help Patient Flashcard
    (PDF - 3.44 MB)
  • Medicare Extra Help Patient Flashcard (Spanish)
    (PDF - 1.70 MB)

XOSPATA® is a registered trademark of Astellas Pharma Inc.

Contact

For help with VEOZAH,
please call 1-866-239-1637.

For help with XOSPATA,
please call 1-844-632-9272.

For help with XTANDI,
please call 1-855-898-2634.

For help with PADCEV,
please call 1-888-402-0627.

For help with CRESEMBA,
please call 1-800-477-6472.

Prescriber portal

Use the Prescriber Portal to enroll your
patients and/or check the status of their claim.

Patient Portal

Visit the Patient Portal
to help you understand your
coverage and reimbursement
options when prescribed
an Astellas medication.

Updated Astellas forms
will be available 01-10-2017.
Please check back then.
We apologize for any inconvenience.

Repository will be available 1/17

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