Contact info
- Phone
- 1-877-577-7756
Eligibility
- This offer is valid only for those with commercial insurance and who have a valid prescription.
- This offer is not valid under Medicare, Medicaid, or any other federal or state program, for cash-paying patients, where product is not covered by patient's commercial insurance, or where plan reimburses you for entire cost of your prescription drug. This offer is not valid where prohibited by law and is only valid in the United States and Puerto Rico.
- Patient will be responsible for up to the first $25 (specific offer varies by brand) and the program pays the remaining co-pay or coinsurance until you reach the yearly maximum of $15,000. After the program maximum, patient is responsible for the difference.
- 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
- None
- 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
- Patient
- Supply per shipment
- Not published
- Time to first delivery
- Not published
- Refills
- Patient brings card to pharmacy for refills.
- Staying enrolled
- Not published
Medications covered
- Adakveo (crizanlizumab-tmca)
- Afinitor (everolimus)
- Exjade (deferasirox)
- Gleevec (imatinib mesylate)
- Jadenu Sprinkle granules (deferasirox)
- Jadenu Tablet (deferasirox)
- Kisqali (ribociclib)
- Kisqali Femara Co-Pack tablets (ribociclib and letrozole)
- Mekinist (trametinib)
- Piqray (alpelisib)
- Promacta