Acute Lymphoblastic Leukemia (ALL) Disease(s) Brand Name … · 2020-03-05 · Acute Promyelocytic...
Transcript of Acute Lymphoblastic Leukemia (ALL) Disease(s) Brand Name … · 2020-03-05 · Acute Promyelocytic...
Disease(s) Brand Name Drug Name Drug Company Phone Number Website
Asparlascalaspargase
pegol-mknl Servier
No financial assistance offered at this
time.
BESPONSA Ozogamicin Wyeth 1-877-744-5675https://www.pfizertogether.com/hcp/bes
ponsa/patient-financial-assistance
Blincyto Blinatumomab Amgen 1-855-669-9360
http://www.amgen.com/responsibility/ac
cess-to-medicine/reimbursement-
support-services-and-financial-
assistance-programs/
Kymriah Tisagenlecleucel Novartis 1-844-459-6742
https://www.hcp.novartis.com/products/
kymriah/acute-lymphoblastic-leukemia-
children/access/
Gleevec® Imatinib Mesylate Novartis 1-800-282-7630http://www.oncologyaccessnow.com/ind
ex.jsp
Gleevec® Generic Imatinib Mesylate Teva 1-844-546-8639 http://www.tevaimatinibsavings.com/
Generic Imatinib Imatinib Mesylate Sun Pharma 1/844-502-5950http://www.imatinibrx.com/home/patient-
assistance-program/
Iclusig® Ponatinib Takeda 1-844-817-6468https://www.takedaoncology1point.com/
patient/financial-assistance
Sprycel® DasatinibBristol-Myers
Squibb1-877-526-7334 https://www.sprycel.com/sprycel-assist
Trisenox Arsenic Trioxide Teva 1-877-237-4881 http://www.tevacares.org/
Acute
Lymphoblastic
Leukemia (ALL)
(Ph negative)
Blincyto Blinatumomab Amgen 1-855-669-9360
http://www.amgen.com/responsibility/ac
cess-to-medicine/reimbursement-
support-services-and-financial-
assistance-programs/
Disease(s) Brand Name Drug Name Drug Company Phone number Website
Dacogen DecitabineGood Days
Program 1-877-968-7233
http://www.needymeds.org/drug_list.taf
?_function=name&name=Dacogen
Idamycin Idarubicin Pfizer 1-866-706-2400http://www.pfizerrxpathways.com/?step
=1&step=1&step=1
IDHIFA Enasidenib Celgene 1-800-931-8691https://www.celgenepatientsupport.com/
enrollment/
Mylotarg Ozogamicin Pfizer 1-844-989-7284 www.pfizerrxpathways.com
Nivestym (a
biosimilar to
Neupogen)
filgrastim-aafi Pfizer 1-844-989-7284 www.pfizerrxpathways.com
RYDAPT Midostaurin Novartis 1-877-557-7756https://www.copay.novartisoncology.co
m
Venclexta VenetoclaxAbbvie/Genentec
h1-855-692-6729
https://www.genentech-
access.com/hcp/brands/venclexta.html
Co-Pay Assistance Resource Guide for Blood Cancer Patients
Acute
Lymphoblastic
Leukemia (ALL) -
B-cell Precursor
Ph+ Acute
Lymphoblastic
Leukemia (ALL)
Acute Myeloid Leukemia (AML)
Acute Myeloid
Leukemia
Acute Lymphoblastic Leukemia (ALL)
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Daurismo Glasdegib Pfizer 877-744-5675https://www.pfizeroncologytogether.com
/
Venclexta VenetoclaxAbbvie/Genentec
h1-855-692-6729
https://www.genentech-
access.com/hcp/brands/venclexta.html
Acute Myeloid
Leukemia (AML)
CD33-Positive
Mylotarg Ozogamicin Pfizer 1-844-989-7284 www.pfizerrxpathways.com
AML Tx for blastic
plasmacytoid
dendritic cell
neoplasm (BPDCN)
in adult and
pediatric patients
two years and older
Elzonris tagraxofusp-erzs Stemline
Therapeutics1-833-478-3654 https://www.stemlinearc.com/
(t-AML) or AML with
Myelodysplasia-
related changes
(AML-MRC)
VYXEOSDaunorubicin -
Cytarabine
Jazz
Pharmaceutical
Jump Start
Program
1-855-589-9367 www.vyxeos.com
Acute Myeloid
Leukemia (AML)
with a susceptible
IDH1 mutation
Tibsovo ivosidenib
Agios
Pharmaceuticals,
Inc.
1-844-409-1141https://www.needymeds.org/papforms/
myaefe2609.pdf
Relapsed or
refractory Acute
Myeloid Leukemia
with an isocitrate
dehydrogenase-2
(IDH2) mutation
IDHIFA Enasidenib Celgene 1-800-931-8691https://www.celgenepatientsupport.com/
enrollment/
RYDAPT Midostaurin Novartis 1-877-557-7756https://www.copay.novartisoncology.co
m
XOSPATA gilteritinibAstellas Pharma
US 1-844-632-9272
https://www.astellaspharmasupportsolut
ions.com/products/xospata/patient_enro
llment_process.aspx
Disease(s) Brand Name Drug Name Drug Company Phone number Website
Acute Myeloid
Leukemia (AML) 75
yrs. and older or
Comorbidities (no
chemo option)
Relapsed or
refractory Acute
Myeloid Leukemia
(AML) with a FLT3
mutation
Acute Promyelocytic Leukemia
Page 2 of 12
Acute
Promyelocytic
Leukemia
VYXEOSDaunorubicin -
Cytarabine
Jazz
Pharmaceutical
Jump Start
Program
1-855-589-9367 www.vyxeos.com
Disease(s) Brand Name Drug Name Drug Company Phone number Website
Steroid-refractory
acute graft-versus-
host disease in
adult and pediactric
patients 12 years
and older
Jakafi® Ruxolitinib Incyte 1-855-452-5234https://www.incytecares.com/jakafi-
copay-assistance.aspx
Disease(s) Brand Name Drug Name Drug Company Phone number Website
Chronic Graft
Versus Host
Disease (cGVHD)
after failure of one
or more lines of
systemic therapy
ImbruvicaTM Ibrutinib
Pharmacyclics/
Janssen 1-877-877-3536
https://www.imbruvica.com/patient-
support/access-support
Disease(s) Brand Name Drug Name Drug Company Phone number Website
Arzerra Ofatumumab Novartis 1-800-282-7630http://www.oncologyaccessnow.com/ind
ex.jsp
COPIKTRA duvelisib Verastem 1-833-570-2273
http://www.verastem.com/wp-
content/uploads/2018/08/verastem-
cares-form.pdf
ImbruvicaTM IbrutinibPharmacuclics/J
anssen Biotech1-877-877-3536
https://www.imbruvica.com/patient-
support/access-support
Rituxan HycelaRituximab and
HyaluronidaseGenentech 1-888-249-4918
https://www.genentech-
access.com/hcp/brands/rituxanhycela/fi
nd-patient-assistance.html
Venclexta VenetoclaxAbbvie/Genentec
h1-855-692-6729
https://www.genentech-
access.com/hcp/brands/venclexta.html
Disease(s) Brand Name Drug Name Drug Company Phone number Website
Chronic
Lymphocytic Arzerra Ofatumumab Novartis 1-800-282-7630
http://www.oncologyaccessnow.com/ind
ex.jsp
Chronic Lymphocytic Leukemia (CLL)
Chronic Graft Versus Host Disease (cGVHD)
Chronic Lymphocytic Leukemia (CLL)/Small Lymphocytic Lymphoma (SLL)
Chronic
Lymphocytic
Leukemia
(CLL)/Small
Lymphocytic
Lymphoma (SLL)
Acute Graft Versus Host Disease (GvHD)
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BendekaBendamustine
HydrochlorideTeva 1-888-587-3263 http://bendeka.com/Support/assistance
Gazyva™ Obinutuzumab Genentech 1-888-249-4918http://www.genentech-
access.com/gazyva/patients
ImbruvicaTM Ibrutinib
Pharmacyclics/
Janssen 1-877-877-3536
https://www.imbruvica.com/patient-
support/access-support
Rituxan® Rituximab Genentech 1-888-249-4918http://www.genentech-
access.com/rituxan-nhl-cll/patients
Rituxan HycelaRituximab and
HyaluronidaseGenentech 1-888-249-4918
https://www.genentech-
access.com/hcp/brands/rituxanhycela/fi
nd-patient-assistance.html
Treanda Bendamustine Teva 1-877-237-4881 http://www.tevacares.org/
Venclexta VenetoclaxAbbvie/Genentec
h1-855-692-6729
https://www.genentech-
access.com/hcp/brands/venclexta.html
Calquence acalabrutinibAstraZeneca
Pharmaceuticals 1-844-275-2360
https://www.calquence.com/patient/sup
port-for-patients/commercial-
insurance.html
Zydelig® Idelalisib Gilead1-844-6ACCESS
(1-844-622-2377)
http://www.zydeligaccessconnect.com/h
cp
COPIKTRA duvelisib Verastem 1-833-570-2273
http://www.verastem.com/wp-
content/uploads/2018/08/verastem-
cares-form.pdf
Venclexta VenetoclaxAbbvie/Genentec
h1-855-692-6729
https://www.genentech-
access.com/hcp/brands/venclexta.html
Previously
untreated chronic
lymphocytic
leukemia (CLL)
Venclexta VenetoclaxAbbvie/Genentec
h1-855-692-6729
https://www.genentech-
access.com/hcp/brands/venclexta.html
Disease(s) Brand Name Drug Name Drug Company Phone number Website
Chronic Myeloid
Leukemia (CML)Bosulif® Bosutinib Pfizer
1-855-4-BOSULIF
1-855-426-7854https://www.bosulif.com/bosulif-steps
Gleevec® Imatinib Mesylate Novartis 1-800-282-7630http://www.oncologyaccessnow.com/ind
ex.jsp
Gleevec® Generic Imatinib Mesylate Teva 1-844-546-8639 http://www.tevaimatinibsavings.com/
Gleevec® Generic Imatinib Mesylate Sun Pharma 1-844-502-5950http://www.imatinibrx.com/home/patient-
assistance-program/
Iclusig® Ponatinib Takeda 1-844-817-6468https://www.takedaoncology1point.com/
patient/financial-assistance
Synribo Omacetaxine Teva 1-877-237-4881 http://www.tevacares.org/
Sprycel® DasatinibBristol-Myers
Squibb1-877-526-7334 https://www.sprycel.com/sprycel-assist
Tasigna® Nilotinib Novartis 1-866-972-5244 www.CoPay.NovartisOncology.com
Chronic
Lymphocytic
Leukemia (CLL)
with 17p deletion
Chronic Myeloid Leukemia (CML)
Chronic
Lymphocytic
Leukemia (CLL)
Chronic Myeloid
Leukemia (CML)
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Newly-diagnosed
chronic phase (CP)
(Ph+)(CML)
Bosulif® Bosutinib Pfizer1-855-4-BOSULIF
1-855-426-7854https://www.bosulif.com/bosulif-steps
Chronic phase (CP)
(Ph+)(CML)Sprycel® Dasatinib
Bristol-Myers
Squibb1-877-526-7334 https://www.sprycel.com/sprycel-assist
PH+ CML chronic
phase/intolerant
prior to TKI
Tasigna® Nilotinib Novartis 1-866-972-5244 www.CoPay.NovartisOncology.com
Disease(s) Brand Name Drug Name Drug Company Phone number Website
Hairy Cell Leukemia LUMOXITI pasudotox-tdfk AstraZeneca
Pharmaceuticals 1-844-275-2360
https://www.myaccess360.com/hcp/hcp-
branded-lumoxiti/support-
services/affordability-support.html
Disease(s) Brand Name Drug Name Drug Company Phone number Website
KEYTRUDA Pembrolizumab Merck & Co 1-855-257-3932https://www.merckaccessprogram-
keytruda.com/hcc/
Opdivo NivolumabBristol-Myers
Squibb1-800-861-0048
http://www.bmsaccesssupport.bmscust
omerconnect.com/opdivo/co-pay-
financial-assistance#
Adcetris®Brentuximab
vedotinSeattle Genetics
1-855-4SEAGEN
1-855-473-2436www.seagensecure.com
Opdivo NivolumabBristol-Myers
Squibb1-800-861-0048
http://www.bmsaccesssupport.bmscust
omerconnect.com/opdivo/co-pay-
financial-assistance#
Classical Hodgkin
lymphoma (cHL) at
high risk of relapse
or progression
Adcetris®Brentuximab
vedotinSeattle Genetics
1-855-4SEAGEN
1-855-473-2436www.seagensecure.com
Refractory Classical
Hodgkin Lymphoma
(cHL)
KEYTRUDA Pembrolizumab Merck & Co 1-855-257-3932https://www.merckaccessprogram-
keytruda.com/hcc/
Erdheim-Chester
Disease (ECD) with
BRAF V600
Mutation
ZELBORAF vemurafenibHoffmann-La
Roche 1-866-422-2377
https://www.genentech-
access.com/patient/brands/zelboraf/pati
ent-assistance-tool-page.html
Hodgkin Lymphoma
(HL)
Classical Hodgkin
lymphoma (cHL)
Hairy Cell Leukemia
Hodgkin lymphoma
Page 5 of 12
Hepatic Veno-
Occlusive Disease
(VOD) following
hematopoietic stem-
cell transplantation
(HSCT)
Defitelio defibrotide sodium Jazz
Pharmaceuticals1-888-837-4397
https://www.jazzpharma.com/responsibil
ity/patient-assistance/
Metastatic
Anaplastic
Lymphoma Kinase
(ALK)-positive non-
small cell lung
cancer (NSCLC)
ALUNBRIG Brigatinib Takeda/ARIAD 1-844-817-6488
https://www.pparx.org/prescription_assi
stance_programs/takeda_oncology_pati
ent_assistance_program
Metastatic Non-
Small Cell Lung
Cancer (NSCLC)
ZYKADIA Ceritinib Novartis 1-888-669-6682https://www.us.zykadia.com/patient-
support/financial-resources/
Disease(s) Brand Name Drug Name Drug Company Phone number Website
Calquence acalabrutinibAstraZeneca
Pharmaceuticals 1-844-275-2360
https://www.myaccess360.com/hcp/hcp-
branded-calquence/support-
services/affordability-support.html
ImbruvicaTM Ibrutinib
Pharmacyclics/
Janssen 1-877-877-3536
https://www.imbruvica.com/patient-
support/access-support
Revlimid® Lenalidomide Celgene 1-800-931-8691https://www.celgenepatientsupport.com/
find-financial-help/
Mantle Cell
Lymphoma who
have received at
least 1 prior therapy
Brukinsa zanubrutinib BeiGene 1-877-828-5568No financial assistance offered at this
time.
Disease(s) Brand Name Drug Name Drug Company Phone number Website
Dacogen DecitabineGood Days
Program 1-877-968-7233
http://www.needymeds.org/drug_list.taf
?_function=name&name=Dacogen
Gleevec® Imatinib Mesylate Novartis 1-866-453-3832http://www.gleevec.com/patient/financial-
assistance.jsp
Gleevec® Generic Imatinib Mesylate Teva 1-844-546-8639 http://www.tevaimatinibsavings.com/
Gleevec® Generic Imatinib Mesylate Sun Pharma 1-844-502-5950http://www.imatinibrx.com/home/patient-
assistance-program/
Revlimid® Lenalidomide Celgene 1-800-931-8691http://www.velcade.com/paying-for-
treatment/
Vidaza Azacitidine Celgene 1-800-931-8691http://www.velcade.com/paying-for-
treatment/
Mantle Cell Lymphoma (MCL)
Mantle Cell
Lymphoma (MCL)
Myelodysplastic Syndromes (MDS)
Myelodysplastic
Syndromes (MDS)
Myelodysplastic
Syndromes (MDS)
Page 6 of 12
Disease(s) Brand Name Drug Name Drug Company Phone number Website
Myelofibrosis Jakafi® Ruxolitinib Incyte1-855-4-JAKAFI
1-855-452-5234
http://www.jakafi.com/IncyteCARES/co-
pay-assistance
Intermediate- 2 or
High Risk Primary
or Secondary (post-
polycythemia vera
or post-essential
thrombocythemia)
Myelofibrosis (MF)
Inrebic ® Fedratinib Celgene1-800-931-8691
EXT 4080
https://celgenepatientsupport.com/inrebi
c-patient
Disease(s) Brand Name Drug Name Drug Company Phone number Website
Darzalex Daratumumab Janssen 1-844-553-2792http://www.janssenaccessone.com/pag
es/darzalex/patientassist/intro.jsp
Doxil DoxorubicinJohnson &
Johnson1-800-652-6227
http://www.goodrx.com/doxil/savings-
tips
Empliciti ElotuzumabBristol-Myers
Squibb1-800-861-0048 http://www.empliciti.com/access
Farydak® Panobinostat Novartis 1-800-282-7630http://www.oncologyaccessnow.com/ind
ex.jsp
ImbruvicaTM Ibrutinib
Pharmacyclics/
Janssen 1-877-877-3536
https://www.imbruvica.com/patient-
support/access-support
Istodax® Romidepsin Celgene 1-800-931-8691 http://www.celgenepatientsupport.com/
Kyprolis™ Carfilzomib Amgen 1-888-427-7478
http://www.amgen.com/responsibility/ac
cess-to-medicine/reimbursement-
support-services-and-financial-
assistance-programs/
Ninlaro Ixazomib Takeda 1-844-617-6468 http://www.ninlaro.com/1point
Pomalyst® Pomalidomide Celgene 1-800-931-8691https://www.celgenepatientsupport.com/
find-financial-help/
Revlimid® Lenalidomide Celgene 1-800-931-8691https://www.celgenepatientsupport.com/
find-financial-help/
Thalomid® Thalidomide Celgene 1-800-931-8691https://www.celgenepatientsupport.com/
find-financial-help/
Velcade Bortezomib Takeda 1-866-835-2233http://www.velcade.com/paying-for-
treatment/
Revlimid® Lenalidomide Celgene 1-800-931-8691https://www.celgenepatientsupport.com/
find-financial-help/
Darzalex Daratumumab Janssen 1-844-553-2792http://www.janssenaccessone.com/pag
es/darzalex/patientassist/intro.jsp
Ninlaro Ixazomib
Millennium
Pharmaceuticals/
Takeda
1-844-617-6468 http://www.ninlaro.com/1point
Myeloma
Myeloma
Myelofibrosis
Myeloma
Multiple Myeloma
who have received
at least one prior
therapy
Page 7 of 12
Multiple Myeloma
who have received
at least two prior
regimens
Farydak® Panobinostat Novartis 1-800-282-7630http://www.oncologyaccessnow.com/ind
ex.jsp
Mulitple Myeloma who
have received at least
two prior therapies
including lenalidomide
and proteasome inhibitor*In combination with
pomalidomide and
dexamethasone
Sarclisa® Isatuximab-irfc Sanofi 1-833-930-2273 SanofiCareAssist.com/Sarclisa
Darzalex Daratumumab Janssen 1-844-553-2792http://www.janssenaccessone.com/pag
es/darzalex/patientassist/intro.jsp
Empliciti ElotuzumabBristol-Myers
Squibb1-800-861-0048 http://www.empliciti.com/access
Multiple Myeloma
newly diagnosed
adult patients who
are ineligible for
autologus stem cell
transplant in
combination with
lenalidomide and
dexamethasone
Darzalex Daratumumab Janssen 1-844-553-2792http://www.janssenaccessone.com/pag
es/darzalex/patientassist/intro.jsp
Multiple Myeloma
newly diagnosed
adult patients who
are eligible for
autologous stem cell
transplant in
combination with
bortezomib,
thalidomide, and
dexamethasone
Darzalex Daratumumab Janssen 1-844-553-2792http://www.janssenaccessone.com/pag
es/darzalex/patientassist/intro.jsp
Relapsed or
refractory multiple
myeloma who have
received at least
one prior therapy in
combination with
lenalidomide and
dexamethasone
Darzalex Daratumumab Janssen 1-844-553-2792http://www.janssenaccessone.com/pag
es/darzalex/patientassist/intro.jsp
Relapsed Multiple
Myeloma who have
received one to
three prior lines of
therapy
Kyprolis™ Carfilzomib Amgen 1-888-427-7478
http://www.amgen.com/responsibility/ac
cess-to-medicine/reimbursement-
support-services-and-financial-
assistance-programs/
Multiple Myeloma
who have received
one to three prior
therapies
Page 8 of 12
Relapsed or
Refractory Multiple
Myeloma (RRMM) who have received at least
four prior therapies and
whose disease is refractory to
at least two proteasome
inhibitors, at least two
immunomodulatory agents,
and an anti-CD38 monoclonal
antibody
Xpovio™ selinexorKaryopharm
Therapeutics Inc
No financial assistance offered at this
time.
Disease(s) Brand Name Drug Name Drug Company Phone number Website
for adult pts w/
relapsed or
refractory (MF) or
(SS) after at least
one prior systemic
therapy
Poteligeomogamulizumab-
kpkc Kyowa Kirin 1-833-552-2737
https://www.poteligeohcp.com/support/c
opay-program.html
Disease(s) Brand Name Drug Name Drug Company Phone number Website
Fulphila (a
biosimilar to
Neulasta)
pegfilgrastim-jmdb Mylan GmbH 1-833-695-2623https://www.mylanadvocateportal.com/
myl/login#/
Nivestym (a
biosimilar to
Neupogen)
filgrastim-aafi Pfizer844-989-PATH
(7284)
https://www.pfizerencompassresources.co
m/sites/default/files/pen-
pfizer_patient_assistance_program_applic
ation_for-pfizer_encompass_patients.pdf
Retacrit epoetin alfa-epbx Hospira Inc 1-844-722-6672https://www.pfizerpro.com/product/retac
rit/hcp
Neutropenia
ZARVIO
(biosimilar for
Neupogen,
approved for same
use)
Filgrastim-sndz Sandoz 1-844-726-3691 http://www.zarxio.com/patient/support/
Disease(s) Brand Name Drug Name Drug Company Phone number Website
Adcetris®Brentuximab
VedotinSeattle Genetics
1-855-4SEAGEN
1-855-473-2436www.seagensecure.com
BendekaBendamustine
HydrochlorideTeva 1-888-587-3263 http://bendeka.com/Support/assistance
Rituxan® Rituximab Genentech 1-888-249-4918http://www.genentech-
access.com/rituxan-nhl-cll/patients
Treanda Bendamustine Teva 1-877-237-4881 http://www.tevacares.org/
Zydelig Idelaisib Gilead 1-844-622-2377
http://www.zydeligaccessconnect.com/p
atient/affording-zydelig/patient-
assistance-program
BPDCN in adults or
pediatric patients 2
years or older
Elzonris Tagraxofusp-erzs Stemline
Therapeutics1-833-478-3654 https://www.stemlinearc.com/
Neutropenia
Mycosis fungoides (MF) or Sézary syndrome (SS)
Neutropenia
Non-Hodgkin’s Lymphoma (all Subtypes)
Non-Hodgkin
Lymphoma (NHL)
Page 9 of 12
Peripheral T-cell
LymphomaIstodax Romidepsin Celgene
1-800-931-8691
ext 4093
https://www.celgenepatientsupport.com/
find-financial-help/
Previously
untreated systemic
anaplastic large cell
lymphoma or other
CD30-expressing
peripheral T-cell
lymphomas
Adcetris®Brentuximab
vedotinSeattle Genetics
1-855-4SEAGEN
1-855-473-2436www.seagensecure.com
ALUNBRIG Brigatinib Takeda/ARIAD 1-844-817-6488
https://www.pparx.org/prescription_assi
stance_programs/takeda_oncology_pati
ent_assistance_program
ZYKADIA Ceritinib Novartis 1-888-669-6682https://www.us.zykadia.com/patient-
support/financial-resources/
CD20-positive, B-
cell non-Hodgkin’s
lymphoma (NHL)
Truxima rituximab-abbs Celltrion/Teva 1-877-237-4881 http://www.tevacares.org/
Poteligeomogamulizumab-
kpkc Kyowa Kirin 1-833-552-2737
https://www.poteligeohcp.com/support/c
opay-program.html
Istodax Romidepsin Celgene1-800-931-8691
ext 4093
https://www.celgenepatientsupport.com/
find-financial-help/
ALIQOPA Copanlisib Bayer 1-833-254-7672
https://www.hcp.aliqopa-us.com/access-
and-reimbursement/patient-and-
financial-support/
Kymriah Tisagenlecleucel Novartis 1-844-459-6742
https://www.hcp.novartis.com/products/
kymriah/acute-lymphoblastic-leukemia-
children/access/
Rituxan HycelaRituximab and
HyaluronidaseGenentech 1-888-249-4918
https://www.genentech-
access.com/hcp/brands/rituxanhycela/fi
nd-patient-assistance.html
Diffuse large B-cell
lymphoma (DLBCL) YESCARTA
axicabtagene
ciloleucel Kite Pharma 1-844-454-5483 https://www.yescarta.com/support
Relapsed or
refractory diffuse
large B-cell
lymphoma after at
least two prior
therapies
Polivypolatuzumab
vedotin-piiqGenentech 866-422-2377
https://www.genentech-
access.com/hcp/brands/polivy/find-
patient-assistance/help-for-uninsured-
patients.html
Previously treated
marginal zone
lymphoma (MZL) in
combination with a
rituximab product
Revlimid® lenalidomide Celgene 1-800-931-8691
https://www.revlimid.com/mm-
patient/affording-revlimid/financial-
assistance/?mm-self-id=yes
ALIQOPA Copanlisib Bayer 1-833-254-7672
https://www.hcp.aliqopa-us.com/access-
and-reimbursement/patient-and-
financial-support/
COPIKTRA duvelisib Verastem 1-833-570-2273
http://www.verastem.com/wp-
content/uploads/2018/08/verastem-
cares-form.pdf
Gazyva™ Obinutuzumab Genentech 1-888-249-4918http://www.genentech-
access.com/gazyva/patients
Diffuse large B-cell
lymphoma (DLBCL)
Follicular
Lymphoma
Anaplastic
Lymphoma Kinase
Cutaneous T-Cell
Lymphoma
Page 10 of 12
Gazyva Injection Obinutuzumab Genentech 1-888-249-4918http://www.genentech-
access.com/gazyva/patients
Rituxan HycelaRituximab and
HyaluronidaseGenentech 1-888-249-4918
https://www.genentech-
access.com/hcp/brands/rituxanhycela/fi
nd-patient-assistance.html
Zydelig® Idelalisib Gilead1-844-6ACCESS
(1-844-622-2377)
http://www.zydeligaccessconnect.com/h
cp
Previously treated
follicular lymphoma
(FL) in combination
with a rituximab
product
Revlimid® lenalidomide Celgene 1-800-931-8691
https://www.revlimid.com/mm-
patient/affording-revlimid/financial-
assistance/?mm-self-id=yes
Disease(s) Brand Name Drug Name Drug Company Phone number Website
(pcALCL) or CD30-
expressing mycosis
fungoides (MF) who
have received prior
systemic therapy
Adcetris®Brentuximab
vedotinSeattle Genetics
1-855-4SEAGEN
1-855-473-2436www.seagensecure.com
Disease(s) Brand Name Drug Name Drug Company Phone number Website
(PMBCL), or pts
who have relapsed
after two or more
prior lines of
therapy
KEYTRUDA Pembrolizumab Merck & Co 1-855-257-3932https://www.merckaccessprogram-
keytruda.com/hcc/
Disease(s) Brand Name Drug Name Drug Company Phone number Website
Zydelig® Idelalisib Gilead1-844-6ACCESS
(1-844-622-2377)
http://www.zydeligaccessconnect.com/h
cp
Calquence acalabrutinibAstraZeneca
Pharmaceuticals 1-844-275-2360
https://www.calquence.com/patient/sup
port-for-patients/commercial-
insurance.html
Venclexta VenetoclaxAbbvie/Genentec
h1-855-692-6729
https://www.genentech-
access.com/hcp/brands/venclexta.html
Previously
untreated small
lymphocytic
lymphoma (SLL)
Venclexta VenetoclaxAbbvie/Genentec
h1-855-692-6729
https://www.genentech-
access.com/hcp/brands/venclexta.html
Disease(s) Brand Name Drug Name Drug Company Phone number Website
Thrombocytopenia TAVALISSE
fostamatinib
disodium
hexahydrate
tablets
Rigel
Pharmaceuticals1-833-744-3562 https://tavalisse.com/
Disease(s) Brand Name Drug Name Drug Company Phone number Website
Thrombocytopenia
Waldenstrom’s Macroglobulinemia (WM)
Follicular
Lymphoma
Primary Cutaneous Anaplastic Large Cell Lymphoma (pcALCL)
Refractory Primary Mediastinal Large B-cell Lymphoma (PMBCL)
Small Lymphocytic Leukemia (SLL)
Small Lymphocytic
Leukemia (SLL)
Page 11 of 12
Waldenstrom’s
macroglobulinemia
(WM)Imbruvica
TM IbrutinibPharmacyclics/
Janssen 1-877-877-3536
https://www.imbruvica.com/patient-
support/access-support
Disease(s) Brand Name Drug Name Drug Company Phone number Website
DefitelioDefibrotide
Sodium
Jazz
Pharmaceuticals1-888-837-4397
https://www.jazzpharma.com/responsibil
ity/patient-assistance/
Granix Tbo-Filgrastim Teva 1-888-587-3263http://www.granixhcp.com/Support/GRA
NIX-CORE.aspx
Idamycin Idarubicin Pfizer 1-844-989-7284 http://www.pfizerrxpathways.com/
Neulasta® (G-
CSF) Pegfilgrastim Amgen
1-888-4ASSIST
1-888-427-7478
http://www.amgen.com/responsibility/ac
cess-to-medicine/reimbursement-
support-services-and-financial-
assistance-programs/
Neupogen® (G-
CSF)Filgrastim Amgen
1-888-4ASSIST
1-888-427-7478
http://www.amgen.com/responsibility/ac
cess-to-medicine/reimbursement-
support-services-and-financial-
assistance-programs/
ZARVIO
(biosimilar for
Neupogen,
approved for same
use)
Filgrastim-sndz Sandoz 1-844-726-3691 http://www.zarxio.com/patient/support/
Procrit Epoetin Alfa Janssen 1-877-227-3728http://www.janssenprescriptionassistanc
e.com/procrit-cost-assistance
Granix TBO-Filgrastim Teva Core 1-888-587-3263
http://www.granixrx.com/Staying-
supported/GRANIX-financial-
assistance.aspx
All Blood Cancers
All Blood Cancers
All Blood Cancers
Page 12 of 12