Contact info
- Phone
- 1-833-324-5322
- Fax
- 1-833-324-5346
Eligibility
- Contact program for details.
- Program provides benefits investigation, co-pay assistance and referral to Patient Assistance Program if eligible.
- Income limit, single
- Not published
- Income limit, couple
- Not published
- Medical expenses can be deducted
- Not published
- Social Security number asked for
- No
- 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
- Who can sign
- Physician
- Application can be faxed
- Yes
- Decision letter sent to
- Provider
Getting the medication
- Patient receives
- Not published
- Shipped to
- Provider
- Supply per shipment
- Not published
- Time to first delivery
- Not published
- Refills
- Not published
- Staying enrolled
- Not published
Medications covered
- Belrapzo (bendamustine hydrochloride injection)
- Pemfexy (pemetrexed injection)