Contact info
- Phone
- 1-844-775-2273
- Fax
- 1-866-981-3072
Eligibility
- Program will provide educational and logistical support as well as discuss financial assistance options that are available for you. Patient Assistance Program and co-pay assistance may be available for eligible patients.
- 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 and patient
Getting the medication
- Patient receives
- Medication
- Shipped to
- Provider
- Supply per shipment
- Not published
- Time to first delivery
- Not published
- Refills
- Not published
- Staying enrolled
- Must re-enroll at end of calendar year.
Medications covered
- Kimmtrak (tebentafusp-tebn)