Contact info
- Phone
- 1-866-264-2778
Eligibility
- Patient must have private insurance and is not participating in any federal, state or government-funded healthcare program, such as Medicare, Medicare Advantage, Medicare Part D, Medicaid, etc.
- Applicant must call for prescreening.
- Income limit, single
- Not published
- Income limit, couple
- Not published
- 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
- Not required
- Who can sign
- Not published
- Application can be faxed
- Not published
- Decision letter sent to
- Not published
Getting the medication
- Patient receives
- Pharmacy card
- Shipped to
- Provider or patient
- Supply per shipment
- Not published
- Time to first delivery
- Not published
- Refills
- Not published
- Staying enrolled
- Card is good for Patients entire course of treatment.
Medications covered
- Avsola injection (infliximab-axxq)
- BKEMV (aflibercept-ayyh)
- Blincyto (blinatumomab)
- Evenity (romosozumab)
- Imdelltra (tarlatamab-dlle)
- Imlygic (talimogene laherparepvec)
- Kanjiniti (trastuzumab-anns)
- Kyprolis Injection (carfilzomib)
- Lumakras (sotorasib)
- Mvasi (bevacizumab-awwb)
- Neulasta Onpro