Contact info
- Phone
- 1-888-537-8277
- Fax
- 1-866-930-1562
- Mailing address
- PO Box 220551Charlotte, NC 28222-0551
Eligibility
- Contact program for details.
- Co-pay assistance, reimbursement support, patient support, and patient assistance programs are 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
- Yes
- 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
- Insurance information, if applicable
- Prescriber license number
- NPI number
- Who can sign
- Physician
- Application can be faxed
- Yes
- Decision letter sent to
- Not published
Getting the medication
- Patient receives
- Not published
- Shipped to
- Not published
- Supply per shipment
- Not published
- Time to first delivery
- Not published
- Refills
- Not published
- Staying enrolled
- Not published
Medications covered
- Beleodaq Powder (belinostat)
- Evomela (melphalan injection)
- Folotyn (pralatrexate injection)
- Khapzory (levoleucovorin injection)
- Ryzneuta (efbemalenograstim alfa-vuxw)