Contact info
- Phone
- 1-844-647-2842
- Fax
- 1-844-647-2844
Eligibility
- Patient must be uninsured or underinsured for patient assistance program.
- Co-pay assistance is also available to eligible patients.
- Income limit, single
- Not published
- Income limit, couple
- $150,000 a year
- Other income rules
- $150,000 for household size of 2 people; $25,000 per additional person in household.
- 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
- Proof of income
- Prescriber license number
- NPI number
- Both DEA and state license numbers
- Who can sign
- Physician
- Application can be faxed
- Yes
- Decision letter sent to
- Not published
Getting the medication
- Patient receives
- Medication
- Shipped to
- Not published
- Supply per shipment
- Not published
- Time to first delivery
- Not published
- Refills
- Not published
- Staying enrolled
- New application every 12 months
- New proof of income every 12 months
Medications covered
- Krazati (adagrasib)