Contact info
- Phone
- 1-877-542-8296
- Fax
- 1-833-853-8362
- Mailing address
- PO Box 220262Charlotte, NC 28211-0262
Eligibility
- Patient must meet income requirements and are uninsured, lack coverage for LIBTAYO, or have Medicare Part B with no supplemental insurance coverage.
- Patients with Medicare Part D are not eligible.
- Program also provides co-pay and reimbursement assistance.
- Income limit, single
- 500% of the federal poverty level
- Income limit, couple
- 500% of the federal poverty level
- Medical expenses can be deducted
- Not published
- Social Security number asked for
- Not published
- US citizenship or residency required
- Yes
Not sure where your income falls? See this year's federal poverty guidelines (opens in a new tab).
Application process
- Documents to attach
- Not published
- Prescriber license number
- NPI number
- Both DEA and state license numbers
- Who can sign
- Physician
- Application can be faxed
- Yes
- Decision letter sent to
- Provider and patient
Getting the medication
- Patient receives
- Varies
- Shipped to
- Provider
- Supply per shipment
- Varies
- Time to first delivery
- Not published
- Refills
- Refill form sent with each supply
- Staying enrolled
- New application every 12 months
Medications covered
- Libtayo injection (cemiplimab-rwlc)