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Co-Pay Assistance Resource Guide for Blood Cancer Patients Acute Lymphoblastic Leukemia (ALL) Disease(s) Brand Name Drug Name Drug Company Phone Number Website calaspargase No financial assistance offered at this Asparlas Servier pegol-mknl time. https://www.pfizertogether.com/hcp/bes BESPONSA Ozogamicin Wyeth 1-877-744-5675 ponsa/patient-financial-assistance Acute Lymphoblastic http://www.amgen.com/responsibility/ac Leukemia (ALL) - B- cess-to-medicine/reimbursement- Blincyto Blinatumomab 1-855-669-9360 cell Precursor support-services-and-financial- assistance-programs/ https://www.hcp.novartis.com/products/k Kymriah Tisagenlecleucel Novartis 1-844-459-6742 ymriah/acute-lymphoblastic-leukemia- children/access/ http://www.oncologyaccessnow.com/ind Gleevec® Imatinib Mesylate Novartis 1-800-282-7630 ex.jsp *not offering patient assistance nor cost savings program* Gleevec® Generic Imatinib Mesylate Teva 1-844-546-8639 https://www.tevagenerics.com/patients/fr Ph+ Acute equently-asked-questions/#q-1-1 Lymphoblastic Generic Imatinib Imatinib Mesylate Sun Pharma 1/844-502-5950 https://rxoutreach.org/ Leukemia (ALL) https://www.takedaoncology1point.com/ Iclusig® Ponatinib Takeda 1-844-817-6468 patient/financial-assistance Bristol-Myers https://www.bmsaccesssupport.bmscust Sprycel® Dasatinib 1-877-526-7334 Squibb omerconnect.com/patient Trisenox Teva 1-877-237-4881 http://www.tevacares.org/ http://www.amgen.com/responsibility/ac Acute Lymphoblastic cess-to-medicine/reimbursement- Leukemia (ALL) Blincyto Blinatumomab Amgen 1-855-669-9360 support-services-and-financial- (Ph negative) assistance-programs/ Acute Myeloid Leukemia (AML) Disease(s) Brand Name Drug Name Drug Company Phone number Website https://www.bmsaccesssupport.bmscust Onureg BMS 1-800-861-0048 omerconnect.com/patient Good Days http://www.needymeds.org/drug_list.taf? Dacogen 1-877-968-7233 Program _function=name&name=Dacogen http://www.pfizerrxpathways.com/?step= Idamycin Pfizer 1-866-706-2400 1&step=1&step=1 https://www.bmsaccesssupport.bmscust IDHIFA Enasidenib Celgene 1-800-931-8691 omerconnect.com/patient Acute Myeloid Mylotarg Ozogamicin Pfizer 1-844-989-7284 www.pfizerrxpathways.com Leukemia Nivestym (a biosimilar to filgrastim-aafi Pfizer 1-844-989-7284 www.pfizerrxpathways.com Neupogen) https://www.copay.novartisoncology.co RYDAPT Midostaurin Novartis 1-877-557-7756 m Abbvie/Genentec https://www.genentech- Venclexta 1-855-692-6729 h access.com/hcp/brands/venclexta.html

Page 1 of 13 Acute Myeloid https://www.pfizeroncologytogether.com Daurismo Glasdegib Pfizer 877-744-5675 Leukemia (AML) 75 yrs. / and older or Abbvie/Genentec https://www.genentech- Comorbidities (no Venclexta Venetoclax 1-855-692-6729 h access.com/hcp/brands/venclexta.html chemo option) Acute Myeloid Leukemia (AML) Mylotarg Ozogamicin Pfizer 1-844-989-7284 www.pfizerrxpathways.com CD33-Positive AML Tx for blastic plasmacytoid dendritic cell neoplasm (BPDCN) Stemline Elzonris tagraxofusp-erzs 1-833-478-3654 https://www.stemlinearc.com/ in adult and pediatric Therapeutics patients two years and older Jazz (t-AML) or AML with - Pharmaceutical Myelodysplasia-related VYXEOS 1-855-589-9367 www.vyxeos.com Jump Start changes (AML-MRC) Program Acute Myeloid Agios Leukemia (AML) with a https://www.needymeds.org/papforms/m Tibsovo ivosidenib Pharmaceuticals, 1-844-409-1141 susceptible IDH1 yaefe2609.pdf Inc. mutation Relapsed or refractory Acute Myeloid Leukemia with an https://www.bmsaccesssupport.bmscust IDHIFA Enasidenib Celgene 1-800-931-8691 isocitrate omerconnect.com/patient dehydrogenase-2 (IDH2) mutation https://www.copay.novartisoncology.co Relapsed or refractory RYDAPT Midostaurin Novartis 1-877-557-7756 m Acute Myeloid https://www.astellaspharmasupportsoluti Leukemia (AML) with a Astellas Pharma XOSPATA gilteritinib 1-844-632-9272 ons.com/products/xospata/patient_enroll FLT3 mutation US ment_process.aspx Newly-diagnosed therapy-related acute myelod leukemia (t- AML) or AML with Daunorubicin - Jazz myelodysplasia-related Vyxeos 1-855-589-9367 www.vyxeos.com Cytarabine Pharmaceuticals changes (AML-MRC) including pediatric patients 1 year and older. Acute Promyelocytic Leukemia Disease(s) Brand Name Drug Name Drug Company Phone number Website Jazz Acute Promyelocytic Daunorubicin - Pharmaceutical VYXEOS 1-855-589-9367 www.vyxeos.com Leukemia Cytarabine Jump Start Program Acute Graft Versus Host Disease (GvHD) Disease(s) Brand Name Drug Name Drug Company Phone number Website

Steroid-refractory acute graft-versus-host https://www.incytecares.com/jakafi- disease in adult and Jakafi® Ruxolitinib Incyte 1-855-452-5234 copay-assistance.aspx pediactric patients 12 years and older Chronic Graft Versus Host Disease (cGVHD) Disease(s) Brand Name Drug Name Drug Company Phone number Website

Page 2 of 13 Chronic Graft Versus Host Disease (cGVHD) Pharmacyclics/ https://www.imbruvica.com/patient- after failure of one or ImbruvicaTM Ibrutinib 1-877-877-3536 Janssen support/access-support more lines of systemic therapy Chronic Lymphocytic Leukemia (CLL)/Small Lymphocytic Lymphoma (SLL) Disease(s) Brand Name Drug Name Drug Company Phone number Website http://www.oncologyaccessnow.com/ind Arzerra Ofatumumab Novartis 1-800-282-7630 ex.jsp http://www.verastem.com/wp- COPIKTRA Verastem 1-833-570-2273 content/uploads/2018/08/verastem- cares-form.pdf Chronic Lymphocytic Pharmacuclics/Ja https://www.imbruvica.com/patient- Leukemia (CLL)/Small ImbruvicaTM Ibrutinib 1-877-877-3536 nssen Biotech support/access-support Lymphocytic Lymphoma (SLL) https://www.genentech- Rituximab and Rituxan Hycela Genentech 1-888-249-4918 access.com/hcp/brands/rituxanhycela/fi Hyaluronidase nd-patient-assistance.html Abbvie/Genentec https://www.genentech- Venclexta Venetoclax 1-855-692-6729 h access.com/hcp/brands/venclexta.html Chronic Lymphocytic Leukemia (CLL) Disease(s) Brand Name Drug Name Drug Company Phone number Website Chronic Lymphocytic http://www.oncologyaccessnow.com/ind Arzerra Ofatumumab Novartis 1-800-282-7630 Leukemia (CLL) ex.jsp

Page 3 of 13 Bendeka Teva 1-888-587-3263 http://bendeka.com/Support/assistance Hydrochloride http://www.genentech- Gazyva™ Obinutuzumab Genentech 1-888-249-4918 access.com/gazyva/patients Pharmacyclics/ https://www.imbruvica.com/patient- ImbruvicaTM Ibrutinib 1-877-877-3536 Janssen support/access-support http://www.genentech- Rituxan® Rituximab Genentech 1-888-249-4918 access.com/rituxan-nhl-cll/patients https://www.genentech- Rituximab and Rituxan Hycela Genentech 1-888-249-4918 access.com/hcp/brands/rituxanhycela/fi Chronic Lymphocytic Hyaluronidase nd-patient-assistance.html Leukemia (CLL) Treanda Bendamustine Teva 1-877-237-4881 http://www.tevacares.org/ Abbvie/Genentec https://www.genentech- Venclexta Venetoclax 1-855-692-6729 h access.com/hcp/brands/venclexta.html https://www.calquence.com/patient/supp AstraZeneca Calquence acalabrutinib 1-844-275-2360 ort-for-patients/commercial- Pharmaceuticals insurance.html 1-844-6ACCESS http://www.zydeligaccessconnect.com/h Zydelig® Gilead (1-844-622-2377) cp http://www.verastem.com/wp- COPIKTRA duvelisib Verastem 1-833-570-2273 content/uploads/2018/08/verastem- Chronic Lymphocytic cares-form.pdf Leukemia (CLL) with 17p deletion Abbvie/Genentec https://www.genentech- Venclexta Venetoclax 1-855-692-6729 h access.com/hcp/brands/venclexta.html Previously untreated Abbvie/Genentec https://www.genentech- chronic lymphocytic Venclexta Venetoclax 1-855-692-6729 h access.com/hcp/brands/venclexta.html leukemia (CLL) Chronic Myeloid Leukemia (CML) Disease(s) Brand Name Drug Name Drug Company Phone number Website

Chronic Myeloid 1-855-4-BOSULIF Bosulif® Bosutinib Pfizer https://www.bosulif.com/bosulif-steps Leukemia (CML) 1-855-426-7854 http://www.oncologyaccessnow.com/ind Gleevec® Imatinib Mesylate Novartis 1-800-282-7630 ex.jsp *not offering patient assistance nor cost savings program* Gleevec® Generic Imatinib Mesylate Teva 1-844-546-8639 https://www.tevagenerics.com/patients/fr equently-asked-questions/#q-1-1 Chronic Myeloid Gleevec® Generic Imatinib Mesylate Sun Pharma 1-844-502-5950 https://rxoutreach.org/ Leukemia (CML) https://www.takedaoncology1point.com/ Iclusig® Ponatinib Takeda 1-844-817-6468 patient/financial-assistance Synribo Omacetaxine Teva 1-877-237-4881 http://www.tevacares.org/ Bristol-Myers https://www.bmsaccesssupport.bmscust Sprycel® Dasatinib 1-877-526-7334 Squibb omerconnect.com/patient Tasigna® Nilotinib Novartis 1-866-972-5244 www.CoPay.NovartisOncology.com Newly-diagnosed 1-855-4-BOSULIF chronic phase (CP) Bosulif® Bosutinib Pfizer https://www.bosulif.com/bosulif-steps 1-855-426-7854 (Ph+)(CML) Chronic phase (CP) Bristol-Myers https://www.bmsaccesssupport.bmscust Sprycel® Dasatinib 1-877-526-7334 (Ph+)(CML) Squibb omerconnect.com/patient PH+ CML chronic phase/intolerant prior Tasigna® Nilotinib Novartis 1-866-972-5244 www.CoPay.NovartisOncology.com to TKI

Page 4 of 13 Adult patients with chronic phase chronic myeloid leukemia (CP- https://www.takedaoncology1point.com/ Iclusig® Ponatinib Takeda 1-844-817-6468 CML) with resistance or patient/financial-assistance intolerance to at least 2 prior kinase inhibitors

Hairy Cell Leukemia Disease(s) Brand Name Drug Name Drug Company Phone number Website https://www.myaccess360.com/hcp/hcp- AstraZeneca Hairy Cell Leukemia LUMOXITI pasudotox-tdfk 1-844-275-2360 branded-lumoxiti/support- Pharmaceuticals services/affordability-support.html Hodgkin lymphoma Disease(s) Brand Name Drug Name Drug Company Phone number Website https://www.merckaccessprogram- KEYTRUDA Pembrolizumab Merck & Co 1-855-257-3932 Hodgkin Lymphoma keytruda.com/hcc/ (HL) Bristol-Myers https://www.bmsaccesssupport.bmscust Opdivo Nivolumab 1-800-861-0048 Squibb omerconnect.com/patient Brentuximab 1-855-4SEAGEN Adcetris® Seattle Genetics www.seagensecure.com Classical Hodgkin vedotin 1-855-473-2436 lymphoma (cHL) Bristol-Myers https://www.bmsaccesssupport.bmscust Opdivo Nivolumab 1-800-861-0048 Squibb omerconnect.com/patient Classical Hodgkin lymphoma (cHL) at high Brentuximab 1-855-4SEAGEN Adcetris® Seattle Genetics www.seagensecure.com risk of relapse or vedotin 1-855-473-2436 progression Relapsed or Refractory https://www.merckaccessprogram- Classical Hodgkin KEYTRUDA Pembrolizumab Merck & Co 1-855-257-3932 keytruda.com/hcc/ Lymphoma (cHL) Pediatric Relapsed or Refractory classical Hodgkin lymphoma https://www.merckaccessprogram- KEYTRUDA Pembrolizumab Merck & Co 1-855-257-3933 (cHL) or cHL that has keytruda.com/hcc/ relapsed after 2 or more lines of therapy Erdheim-Chester https://www.genentech- Hoffmann-La Disease (ECD) with ZELBORAF vemurafenib 1-866-422-2377 access.com/patient/brands/zelboraf/pati Roche BRAF V600 Mutation ent-assistance-tool-page.html Hepatic Veno-Occlusive Disease (VOD) Jazz https://www.jazzpharma.com/responsibil following Defitelio defibrotide sodium 1-888-837-4397 Pharmaceuticals ity/patient-assistance/ hematopoietic stem-cell transplantation (HSCT) Metastatic Anaplastic Lymphoma Kinase https://www.pparx.org/prescription_assis (ALK)-positive non- ALUNBRIG Brigatinib Takeda/ARIAD 1-844-817-6488 tance_programs/takeda_oncology_patie small cell lung cancer nt_assistance_program (NSCLC) Metastatic Non-Small https://www.us.zykadia.com/patient- Cell Lung Cancer ZYKADIA Ceritinib Novartis 1-888-669-6682 support/financial-resources/ (NSCLC) (MCL) Disease(s) Brand Name Drug Name Drug Company Phone number Website

Page 5 of 13 https://www.myaccess360.com/hcp/hcp- AstraZeneca Calquence acalabrutinib 1-844-275-2360 branded-calquence/support- Pharmaceuticals services/affordability-support.html Mantle Cell Lymphoma Pharmacyclics/ https://www.imbruvica.com/patient- (MCL) ImbruvicaTM Ibrutinib 1-877-877-3536 Janssen support/access-support https://www.bmsaccesssupport.bmscust Revlimid® Celgene 1-800-931-8691 omerconnect.com/patient Mantle Cell Lymphoma No financial assistance offered at this who have received at Brukinsa zanubrutinib BeiGene 1-877-828-5568 time. least 1 prior therapy

Relapsed or Refractory brexucabtagene Mantle Cell Lymphoma Tecartus® Gilead 1-844-454-KITE https://www.kitekonnect.com/ autoleucel (MCL) in adults Myelodysplastic Syndromes (MDS) Disease(s) Brand Name Drug Name Drug Company Phone number Website Good Days http://www.needymeds.org/drug_list.taf? Dacogen Decitabine 1-877-968-7233 Program _function=name&name=Dacogen http://www.gleevec.com/patient/financial- Gleevec® Imatinib Mesylate Novartis 1-866-453-3832 Myelodysplastic assistance.jsp Syndromes (MDS) Gleevec® Generic Imatinib Mesylate Teva 1-844-546-8639 http://www.tevaimatinibsavings.com/ http://www.imatinibrx.com/home/patient- Gleevec® Generic Imatinib Mesylate Sun Pharma 1-844-502-5950 assistance-program/ https://www.bmsaccesssupport.bmscust Revlimid® Lenalidomide Celgene 1-800-931-8691 Myelodysplastic omerconnect.com/patient Syndromes (MDS) https://www.bmsaccesssupport.bmscust Vidaza Azacitidine Celgene 1-800-931-8691 omerconnect.com/patient

Myelodysplastic Syndromes (MDS),in adults, including previously treated and untreated, do novo and secondary MDS decitabine and No financial assistance offered at this Inqovi® Otsuka 1-844-878-2446. with specific French- cedazuridine time. America-Britsh subtypes and intermediate-1, intermediate-2, and high-risk International Prognostic Scoring System groups.

Very low- to intermediate- risk myelodysplastic syndromes with ring sideroblasts (MDS-RS) or with 1-800-931-8691, https://www.celgenepatientsupport.com/ Reblozyl® luspatercept-aamt Celgene myelodysplastic/myelopro EXT 4110 reblozyl-patient/find-financial-help/ liferative neoplasm with ring sideroblasts and thrombocytosis (MDS/MPN-RS-T).

Page 6 of 13 Myelofibrosis Disease(s) Brand Name Drug Name Drug Company Phone number Website 1-855-4-JAKAFI http://www.jakafi.com/IncyteCARES/co- Myelofibrosis Jakafi® Ruxolitinib Incyte 1-855-452-5234 pay-assistance Intermediate- 2 or High Risk Primary or Secondary (post- 1-800-931-8691 https://celgenepatientsupport.com/inrebi polycythemia vera or Inrebic ® Fedratinib Celgene EXT 4080 c-patient post-essential thrombocythemia) Myelofibrosis (MF) Myeloma Disease(s) Brand Name Drug Name Drug Company Phone number Website http://www.janssenaccessone.com/page Darzalex Daratumumab Janssen 1-844-553-2792 s/darzalex/patientassist/intro.jsp Johnson & http://www.goodrx.com/doxil/savings- Doxil 1-800-652-6227 Johnson tips Bristol-Myers Empliciti Elotuzumab 1-800-861-0048 http://www.empliciti.com/access Squibb http://www.oncologyaccessnow.com/ind Farydak® Novartis 1-800-282-7630 ex.jsp Pharmacyclics/ https://www.imbruvica.com/patient- ImbruvicaTM Ibrutinib 1-877-877-3536 Myeloma Janssen support/access-support Istodax® Celgene 1-800-931-8691 http://www.celgenepatientsupport.com/ http://www.amgen.com/responsibility/ac cess-to-medicine/reimbursement- Kyprolis™ Amgen 1-888-427-7478 support-services-and-financial- assistance-programs/ Ninlaro Takeda 1-844-617-6468 http://www.ninlaro.com/1point https://www.celgenepatientsupport.com/ Pomalyst® Pomalidomide Celgene 1-800-931-8691 find-financial-help/ https://www.celgenepatientsupport.com/ Revlimid® Lenalidomide Celgene 1-800-931-8691 find-financial-help/ https://www.celgenepatientsupport.com/ Thalomid® Thalidomide Celgene 1-800-931-8691 find-financial-help/ Myeloma http://www.velcade.com/paying-for- Velcade Takeda 1-866-835-2233 treatment/ https://www.celgenepatientsupport.com/ Revlimid® Lenalidomide Celgene 1-800-931-8691 find-financial-help/ http://www.janssenaccessone.com/page Darzalex Daratumumab Janssen 1-844-553-2792 who s/darzalex/patientassist/intro.jsp have received at least Millennium one prior therapy Ninlaro Ixazomib Pharmaceuticals/ 1-844-617-6468 http://www.ninlaro.com/1point Takeda Multiple Myeloma who http://www.oncologyaccessnow.com/ind have received at least Farydak® Panobinostat Novartis 1-800-282-7630 ex.jsp two prior regimens

Mulitple Myeloma who have received at least two prior therapies including lenalidomide and Sarclisa® -irfc Sanofi 1-833-930-2273 SanofiCareAssist.com/Sarclisa inhibitor *In combination with pomalidomide and dexamethasone http://www.janssenaccessone.com/page Multiple Myeloma who Darzalex Daratumumab Janssen 1-844-553-2792 s/darzalex/patientassist/intro.jsp have received one to Bristol-Myers three prior therapies Empliciti Elotuzumab 1-800-861-0048 http://www.empliciti.com/access Squibb

Page 7 of 13 Multiple Myeloma adult 1-877- patients who have Karyopharm https://www.xpovio.com/rrmm/support- Xpovio™ KARY4WD (1-877- received at lease 1 prior Therapeutics Inc and-resources 527-9493) therapy Multiple Myeloma newly diagnosed adult patients who are ineligible http://www.janssenaccessone.com/page Darzalex Daratumumab Janssen 1-844-553-2792 for autologus stem cell s/darzalex/patientassist/intro.jsp transplant in combination with lenalidomide and dexamethasone Multiple Myeloma newly diagnosed adult patients who are eligible http://www.janssenaccessone.com/page for autologous stem cell Darzalex Daratumumab Janssen 1-844-553-2792 transplant in combination s/darzalex/patientassist/intro.jsp with bortezomib, thalidomide, and dexamethasone Relapsed or refractory multiple myeloma who have received at least http://www.janssenaccessone.com/page Darzalex Daratumumab Janssen 1-844-553-2792 one prior therapy in s/darzalex/patientassist/intro.jsp combination with lenalidomide and dexamethasone Relapsed Multiple http://www.amgen.com/responsibility/ac Myeloma who have cess-to-medicine/reimbursement- Kyprolis™ Carfilzomib Amgen 1-888-427-7478 received one to three support-services-and-financial- prior lines of therapy assistance-programs/ Relapsed or refractory multiple myeloma in adult patients who have received 1 to 3 prior Sarclisa® Isatuximab-irfc Sanofi 1-833-930-2273 SanofiCareAssist.com/Sarclisa lines of therapy (in combination with carfilzomib and dexamethasone)

Relapsed or Refractory Multiple Myeloma (RRMM) who have received at least four prior therapies and whose disease is Karyopharm https://www.xpovio.com/rrmm/support- Xpovio™ selinexor refractory to at least two Therapeutics Inc and-resources proteasome inhibitors, at least two immunomodulatory agents, and an anti-CD38 monoclonal antibody

Relapsed or Refrectory Multiple Myeloma after four or more prior lines of Bristol-Myers therapy, including an idecabtagene No financial assistance offered at this Abecma® Squibb and immunomodulatory vicleucel time. Bluebird Bio agent, a and an anti-CD38 monoclonal antibody

Page 8 of 13 Relapsed or Refractory Multiple Myeloma for adult patietns who have received at least 4 prior belantamab https://www.togetherwithgskoncology.co Blenrep GSK 1‑844‑447‑5662 therapies including anti- mafodotin-blmf m/patient-information/blenrep/ CD38 monoclonal antibody, a proteasome inhibitor and an immunomodulatory agent.

Relapsed or Refractory multiple myeloma for adult patients in combination with dexamethasone who have received at least 4 prior No financial assistance offered at this lines of therapy and Pepaxto® Oncopeptides N/A flufenamide time. whose disease is refractory to at least one proteasome inhibitor, one immunomodulatory agent and one CD38-directed monoclonal antibody.

Mycosis fungoides (MF) or Sézary syndrome (SS) Disease(s) Brand Name Drug Name Drug Company Phone number Website for adult pts w/ relapsed or refractory mogamulizumab- https://www.poteligeohcp.com/support/c (MF) or (SS) after at Poteligeo Kyowa Kirin 1-833-552-2737 kpkc opay-program.html least one prior systemic therapy Neutropenia Disease(s) Brand Name Drug Name Drug Company Phone number Website Fulphila (a https://www.mylanadvocateportal.com/m biosimilar to pegfilgrastim-jmdb Mylan GmbH 1-833-695-2623 yl/login#/ Neulasta)

Nivestym (a https://www.pfizerencompassresources.com Neutropenia 844-989-PATH biosimilar to filgrastim-aafi Pfizer /sites/default/files/pen- (7284) Neupogen) pfizer_patient_assistance_program_applicat ion_for-pfizer_encompass_patients.pdf https://www.pfizerpro.com/product/retacr Retacrit epoetin alfa-epbx Hospira Inc 1-844-722-6672 it/hcp ZARVIO (biosimilar for Neutropenia Neupogen, Filgrastim-sndz Sandoz 1-844-726-3691 http://www.zarxio.com/patient/support/ approved for same use) Non-Hodgkin’s Lymphoma (all Subtypes) Disease(s) Brand Name Drug Name Drug Company Phone number Website

Brentuximab 1-855-4SEAGEN Adcetris® Seattle Genetics www.seagensecure.com Vedotin 1-855-473-2436 Bendamustine Bendeka Teva 1-888-587-3263 http://bendeka.com/Support/assistance Hydrochloride Non-Hodgkin http://www.genentech- Lymphoma (NHL) Rituxan® Rituximab Genentech 1-888-249-4918 access.com/rituxan-nhl-cll/patients Treanda Bendamustine Teva 1-877-237-4881 http://www.tevacares.org/

Page 9 of 13 Non-Hodgkin Lymphoma (NHL)

http://www.zydeligaccessconnect.com/p Zydelig Idelaisib Gilead 1-844-622-2377 atient/affording-zydelig/patient- assistance-program BPDCN in adults or Stemline pediatric patients 2 Elzonris Tagraxofusp-erzs 1-833-478-3654 https://www.stemlinearc.com/ Therapeutics years or older Peripheral T-cell 1-800-931-8691 https://www.celgenepatientsupport.com/ Istodax Romidepsin Celgene Lymphoma ext 4093 find-financial-help/ Previously untreated systemic anaplastic large cell lymphoma or Brentuximab 1-855-4SEAGEN Adcetris® Seattle Genetics www.seagensecure.com other CD30-expressing vedotin 1-855-473-2436 peripheral T-cell lymphomas https://www.pparx.org/prescription_assis ALUNBRIG Brigatinib Takeda/ARIAD 1-844-817-6488 tance_programs/takeda_oncology_patie Anaplastic Lymphoma nt_assistance_program Kinase https://www.us.zykadia.com/patient- ZYKADIA Ceritinib Novartis 1-888-669-6682 support/financial-resources/ CD20-positive, B-cell non-Hodgkin’s Truxima rituximab-abbs Celltrion/Teva 1-877-237-4881 http://www.tevacares.org/ lymphoma (NHL) mogamulizumab- https://www.poteligeohcp.com/support/c Poteligeo Kyowa Kirin 1-833-552-2737 Cutaneous T-Cell kpkc opay-program.html Lymphoma 1-800-931-8691 https://www.celgenepatientsupport.com/ Istodax Romidepsin Celgene ext 4093 find-financial-help/ https://www.hcp.aliqopa-us.com/access- ALIQOPA Bayer 1-833-254-7672 and-reimbursement/patient-and-financial- support/ Diffuse large B-cell https://www.hcp.novartis.com/products/k lymphoma (DLBCL) Kymriah Tisagenlecleucel Novartis 1-844-459-6742 ymriah/acute-lymphoblastic-leukemia- children/access/ https://www.genentech- Rituximab and Rituxan Hycela Genentech 1-888-249-4918 access.com/hcp/brands/rituxanhycela/fi Hyaluronidase nd-patient-assistance.html Diffuse large B-cell axicabtagene YESCARTA Kite Pharma 1-844-454-5483 https://www.yescarta.com/support lymphoma (DLBCL) ciloleucel Relapsed or refractory loncastuximab ADC large B-cell lymphoma Zynlonta 1-855-690-0340 https://advancingpatientsupport.com/ tesirine-lpyl Therapeutics in adult patients

Relapsed or refractory https://www.genentech- diffuse large B-cell polatuzumab access.com/hcp/brands/polivy/find- Polivy Genentech 866-422-2377 lymphoma after at least vedotin-piiq patient-assistance/help-for-uninsured- two prior therapies patients.html

Relapsed or Refractory Diffuse Large B-Cell Lymphoma (DLBCL) (in combination with MorphoSys and lenalidomide) for adults Monjuvi® tafasitamab-cxix n/a https://www.mymissionsupport.com/ including DLBCL arising Incyte from low grade lymphoma and who are not eligible for autologous stem cell transplant

Page 10 of 13 Adult patients with relapsed or refractory large B-cell lymphoma after two or more lines of systemic therapy, including loncastuximab ADC Zynlonta™ 1-855-690-0340 https://advancingpatientsupport.com/ diffuse large B-cell tesirine-lpyl Therapeutics lymphoma (DLBCL) not otherwise specified, DLBCL arising from low grade lymphoma, and high-grade B- cell lymphoma

Adult patients with relapsed large refractory large large B- cell lymphoma after two https://www.bms.com/patient-and- lisocabtagene Bristol-Myers or more lines of Breyanzi® n/a caregivers/get-help-paying-for-your- maraleucel Squibb systemic therapy including medicines.html diffuse large B-cell lymphoma, not otherwise specified, high grade B- cell lymphoma, primary mediastinal large b-cell lymphoma, and grade 3B

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