Contact info
- Phone
- 1-855-257-3932
- Fax
- 1-855-755-0518
- Mailing address
- PO Box 2349Columbus, OH 43216
Eligibility
- Patient eligibility determined on case-by-case basis.
- 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
- Prescription
- Prescriber license number
- NPI number
- State license 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
- Not published
- Supply per shipment
- Not published
- Time to first delivery
- Not published
- Refills
- Patient must contact the program for refills.
- Staying enrolled
- New application every 12 months
Medications covered
- Keytruda (pembrolizumab)
- Keytruda Qlex (pembrolizumab and berahyaluronidase alfa-pmph)
- Prevymis (letermovir)