Medical information Request

Our focus areas

Charitable contributions are provided to support the following:

Through our charitable contribution efforts, Ipsen provides donations to 501 (c)(3) organizations located in the US that are aligned with our company social responsibility priorities and focus on 1) health and social service initiatives aimed at improving patients’ lives, especially in the areas of oncology, neuroscience and rare diseases; 2) science, technology, engineering and mathematics or STEM education programs; 3) environment sustainability; and 4) initiatives that aim to strengthen and address critical needs in communities where our employees live and work.

Eligibility criteria

Funding is provided to nonprofit organizations that are designated as tax-exempt under IRS Code section 501(c)(3).

The following types of support are ineligible for funding:

  • Requests to individual healthcare professionals or group practices in a position to prescribe, purchase, recommend, refer, or arrange for the purchase, sale, or formulary placement of Ipsen products as a healthcare provider, including, but not limited to, physicians, nurses, nurse practitioners, medical directors, hospitals, healthcare professional students, pharmacists, and any individual employed by such provider entities.
  • Support for individuals

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What you need


For consideration, a charitable contribution application must contain all of the following documents and be submitted at least 90 days prior to the event to allow enough time for proper review by the CFC and for the funding to be received before the event occurs.

Letter of Request – must include:

  • A description of your organization, charitable mission and why it is important
  • The relationship, if any, of your organization to Ipsen
  • The date(s) of the program or event (if applicable)
  • The total budget and the donation amount and percentage being requested from Ipsen
  • The projected number of attendees (if applicable)
  • The program location, including the venue, city, and state (if applicable)
  • The payee and address
  • In the case of requests for product (in-kind support), the requested quantity of drug and the way the drug will be used in the program
  • Agenda or brochure—including a detailed description of the program or a synopsis of materials to be created (if applicable)
  • Evidence of the existence of the organization and 501(c)(3) status, such as a tax identity number
  • A description of any prior donations made by Ipsen to the organization and how they were used
  • The number of donors, other than Ipsen, that are being approached to support the request

Agenda or brochure – including a detailed description of the event or a synopsis of materials to be created

Budget – a detailed budget for the total event/project, including (a) the total amount of funds requested from Ipsen Biopharmaceuticals, Inc.; (b) a breakdown of expenses and, if applicable, projected number of attendees; (c) the percentage of funding requested from Ipsen Biopharmaceuticals, Inc., to the total funding for the activity; and (d) the number of donors that are being approached to support the event. Preference will be given to those events funded by more than one donor.

W9 – tax form with tax ID number for the entity receiving the check. If an entity is tax exempt, you may submit a Letter of Exemption instead. Click here to download a W-9 form.

Letter of Agreement (LOA) – A LOA is required for funding all charitable contribution requests.

What you need

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