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1. Benefit Verification and Authorization Support 2. Drug Company Copay Assistance 3

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1. Benefit Verification and Authorization Support 2. Drug Company Copay Assistance 3 Drug Name Brand Name Drug Company 1 2 3 4 5 6 Phone number Website 13-cis-Retinoic Acid Accutane X 2-CdA Leustatin D, H see # 3 below 2-Chlorodeoxyadenosine Leustatin D, H see # 3 below 5-Azacitidine Vidaza Celgene X D,H,P X 1-800-931-8691 www.celgenepatientsupport.com 5FU Adrucil D, H see # 3 below 6-Mercaptopurine Purinethol H X 1-800-675-8416 www.healthwellfoundation.org 6-MP Purinethol H X 1-800-675-8416 www.healthwellfoundation.org 6-TG Thioguanine Tab X X 1-855-382-1280 https://rebates.com/thioguanine-coupon/ 6-Thioguanine Thioguanine Tab X X 1-855-382-1280 https://rebates.com/thioguanine-coupon/ Abiraterone acetate Zytiga Janssen Biotech X X 1-800-652-6227 www.janssenaccessone.com/pages/zytiga/patientassist/intro.jsp Actinomycin-D Cosmegen Recordati Rare Diseases D, H X Ado-trastuzumab emtansine Kadcyla Genentech X X D,H,P X 1-866-422-2377 www.genentech-access.com/hcp Afatinib Gilotrif Tablets Boehringer Ingelheim P 1-866-316-7263 www.panfoundation.org/fundingapplication Alemtuzumab Campath Genzyme X D,H,P X Aldesleukin Proleukin Prometheus X X 1-877-776-5385 www.proleukin.com/mm/resources.aspx Alitretinoin Panretin Eisai X X 1-800-769-3880 www.eisaireimbursement.com Altretamine Hexalen Eisai X X 1-800-769-3880 www.eisaireimbursement.com Amifostine Ethyol D, H see # 3 below Aminoglutethimide Cytadren H 1-800-675-8416 www.healthwellfoundation.org Anagrelide Agrylin X Anastrozole Arimidex Astra Zeneca A X 1-800-292-6363 www.astrazenecaspecialtysavings.com Aprepitant Emend Merck X X D, H X 1-855-257-3932 www.merckaccessprogram.com/hcp/emend-capsules/ ARA-C Cytosar-U H 1-800-675-8416 www.healthwellfoundation.org Arsenic trioxide Trisenox Cephalon X P X 1-888-587-3263 www.cephaloncares.com Asparaginase Elspar Merck D, H see # 3 below Atezolizumab Tecentriq Genentech X X D,H,P X 1-866-422-2377 www.genentech-access.com/hcp ATRA Vesanoid X Axitinib Inlynta Pfizer X X D, P X 1-866-706-2400 www.pfizerrxpathways.com Azacitidine Vidaza Celgene X D,H,P X 1-800-931-8691 www.celgenepatientsupport.com BCG TheraCys Sanofi P X 1-866-316-7263 www.panfoundation.org/fundingapplication BCNU BiCNU Emcure Pharmaceuticals X D, H X 1-800-675-8416 www.healthwellfoundation.org Bendamustine Treanda Cephalon X H,P,A,F X 1-888-587-3263 www.cephalononcologycore.com/ Bexarotene Targretin Eisai X P X 1-888-479-6337 www.targretin.com Bevacizumab Avastin Genentech X X D,H,P X 1-866-422-2377 www.genentech-access.com/hcp Bicalutamide Casodex Astra Zeneca D, R,U X 1-800-292-6363 www.astrazeneca-us.com/help-affording-your-medicines Blenostat Beleodaq Spectrum Pharmaceticals X X X 1-866-930-1562 www.spectrumpatientaccess.com Bleomycin Blenoxane X H 1-800-675-8416 www.healthwellfoundation.org Blinatumomab Blincyto Onyx Pharmaceuticals X X X 1-855-669-9360 www.amgenassist360.com/hcp/ Bortezomib Velcade Millennium X D,H,P X 1-866-835-2233 www.velcade.com/payingfortreatment.aspx Bosutinib Bosulif Pfizer X X D, P X 1-866-706-2400 www.pfizerrxpathways.com Brentuximab vedotin Adcetris Seattle Genetics X X P X 1-855-473-2436 www.seagensecure.com Busulfan Myleran X C225 Erbitux Bristol-Myers Squibb X D,H,P X 1-800-861-0048 www.destinationaccess.com Cabozantinib Cabometyx Exelixis P 1-866-316-7263 www.panfoundation.org/fundingapplication Capecitabine Xeloda Genentech X X D,H,P X 1-866-422-2377 www.genentech-access.com/hcp 1. Benefit Verification and authorization Support 2. Drug Company Copay assistance 3. Foundation Assistance 4. Oral Prescription Savings and/or Free Medication 5. IV Injectable Drugs ongoing and/or Replacement Program 6. No Drug Assistance Drug Name Brand Name Drug Company 1 2 3 4 5 6 Phone number Website Carboplatin Paraplatin H 1-800-675-8416 www.healthwellfoundation.org Carfilzomib Kyprolis Onyx X X P X 1-855-669-9360 www.onyx.com/therapies/patient-access/onyx-360 Carmustine BiCNU Bristol-Myers Squibb X D, H X 1-800-736-0003 www.bmspaf.org Ceritinib Zykadia Norvartis X H,P,F X 1-800-245-5356 www.patientassistancenow.com Cetuximab Erbitux Bristol-Myers Squibb X D,H,P X 1-800-861-0048 www.destinationaccess.com Chlorambucil Leukeran X P 1-866-316-7263 www.panfoundation.org/index.php/en/ Cisplatin Platinol H 1-800-675-8416 www.healthwellfoundation.org Cisplatin Platinol-AQ H 1-800-675-8416 www.healthwellfoundation.org Cladribine Leustatin D, H see # 3 below Clofarabine Clolar Genzyme X X 1-800-792-5652 www.clolar.com/Hcp-financial-assistance-information Cobimetinib Cotellic Genentech X X H, P X 1-866-422-2377 www.genentech-access.com/hcp CPT-11 Camptosar Pfizer X D,H,P X 1-866-706-2400 www.pfizerrxpathways.com Crizotinib Xalkori Pfizer X X 1-866-706-2400 www.pfizerrxpathways.com Cyclophosphamide Cytoxan H 1-800-675-8416 www.healthwellfoundation.org Cyclophosphamide Neosar H 1-800-675-8416 www.healthwellfoundation.org Cytarabine Cytosar-U H 1-800-675-8416 www.healthwellfoundation.org Dabrafenib Tafinlar Novartis X H,A,F,P X X 1-800-245-5356 www.patientassistancenow.com Dactinomycin Cosmegen Recordati Rare Diseases D, H X Dacarbazine DTIC H 1-800-675-8416 www.healthwellfoundation.org Daratumumab Darzalex Janssen Biotech, Inc X X H, P X 1-844-553-2792 www.janssenaccessone.com/pages/darzalex/index.jsp Darbepoetin Aranesp Amgen X H,P,F X 1-888-427-7478 www.AmgenAssistOnline.com Dasatinib Sprycel Bristol-Myers Squibb X X 1-800-861-0048 www.destinationaccess.com Daunorubicin Cerubidine X Decitabine Dacogen Otsuka America H, P 1-866-316-7263 www.panfoundation.org/index.php/en/ Deferasirox Exjade Novartis X X 1-800-245-5356 www.patientassistancenow.com Degarelix Firmagon Ferring X P 1-877-971-3778 www.firmagononline.com Denileukin diftitox Ontak Eisai X X 1-866-613-4724 Denosumab Prolia Amgen X X H,P,F X 1-888-427-7487 www.AmgenAssistOnline.com Denosumab Xgeva Amgen X X H,P,F X 1-888-427-7487 www.AmgenAssistOnline.com Dexrazoxane Totect TopoTarget Dexrazoxane Zinecard Pfizer X X X 1-866-706-2400 www.pfizerrxpathways.com Dinutuximab Unituxin United Therapeutics Corp P Docetaxel Taxotere Sanofi-aventis D,H,P X 1-866-316-7263 www.panfoundation.org/index.php/en/ Doxorubicin Adriamycin H 1-800-675-8416 www.healthwellfoundation.org Doxorubicin Liposome Doxil Janssen Biotech, Inc X D,H,P X 1-800-609-1083 www.doxiline.com/pages/doxil/call-center/introduction.jsp Elotuzumab Empliciti Bristol-Myers Squibb Eltrombopag Promacta Novartis X X H,A,F,P X 1-800-245-5356 www.patientassistancenow.com Enzalutamide Xstandi Astellas X D, P X 1-855-898-2634 www.xtandi.com/getting-xtandi Epirubicin Ellence Pfizer X D, H X 1-866-706-2400 www.pfizerrxpathways.com Epoetin Alpha Procrit Janssen Biotech, Inc X D, H X 1-800-553-3851 www.janssenprescriptionassistance.com/procrit-cost-assistance Eribulin mesylate Halaven Eisai X P X 1-866-614-4724 www.eisaipatientassistance.com Erlotinib Tarceva Genentech X X H, P X 1-866-422-2377 www.genentech-access.com/hcp Erwinia Asparaginase Elspar D, H see #3 below Estramustine Emcyt Pfizer X X P X 1-866-706-2400 www.pfizerrxpathways.com Etoposide Etopophos Bristol-Myers Squibb H X 1-800-736-0003 www.bmspaf.org/program4.html 1. Benefit Verification and authorization Support 2. Drug Company Copay assistance 3. Foundation Assistance 4. Oral Prescription Savings and/or Free Medication 5. IV Injectable Drugs ongoing and/or Replacement Program 6. No Drug Assistance Drug Name Brand Name Drug Company 1 2 3 4 5 6 Phone number Website Etoposide VePesid H 1-800-675-8416 www.healthwellfoundation.org Etoposide Toposar H 1-800-675-8416 www.healthwellfoundation.org Everolimus Afinitor Novartis X D, P X 1-800-245-5356 www.patientassistancenow.com Exemestane Aromasin Pfizer X X H,P,U X 1-866-706-2400 www.pfizerrxpathways.com Filgrastim Neupogen Amgen X D,H,P X 1-888-762-6436 www.AmgenAssistOnline.com Filgrastim-sndz Zarxio Sandoz X X X 1-844-726-3501 www.sandozonesource.com Finasteride Proscar Merck M 1-800-769-3800 www.rxoutreach.org Flourouracil 5FU D, H see # 3 below Floxuridine FUDR H 1-800-675-8416 www.healthwellfoundation.org Fludarabine Fludara H, P see # 3 below Fluoxymesterone Halotestin H 1-800-675-8416 www.healthwellfoundation.org Flutamide Eulexin H, P see # 3 below Fosaprepitant Emend Merck X X D, H X 1855-257-3932 www.merckaccessprogram.com/hcp/emend-for-injection Fulvestrant Faslodex Astra Zeneca D,H,P X 1-800-292-6363 www.astrazenecaspecialtysavings.com Gefitinib Iressa Astra Zeneca H, P X 1-800-292-6363 www.astrazenecaspecialtysavings.com Gemcitibine Gemzar Eli Lilly D,H,P X 1-866-472-8663 www.lillypatientone.com Gemtuzumab Ozogamicin Mylotarg Pfizer X X H,P,U X 1-866-706-2400 www.pfizerrxpathways.com Goserlin Zoladex Astra Zeneca D,H,P X 1-800-292-6363 www.astrazenecaspecialtysavings.com Granisetron Transdermal Sancuso ProStraken X X D X X 1-800-676-5884 www.patientrxsolutions.com Hydroxyurea Droxia Bristol-Myers Squibb A X 1-800-736-0003 www.bmspaf.org Hydroxyurea Hydrea H,U,M see #3 below Ibritumomab Tiuxetin Zevalin Cell Therapeutics X X 1-800-386-9997 www.zevalin.com/H500-reimbursement-financial-support.aspx Ibrutinib Imbryvica Pharmalytics, Inc Idarubicin Idamycin Pfizer X X X 1-866-706-2400 www.pfizerrxpathways.com Idarucizumab Praxbind Boehringer Ingelheim Idelalisib Zydelig GileadSciences, Inc X 1-844-622-2377 www.zydeligaccessconnect.com/hcp/afford/patient-assistance-program Ifosfamide Ifex H 1-800-675-8416 www.healthwellfoundation.org IL-2 Proleukin Prometheus X X 1-877-776-5385 www.proleukin.com/patient/resources IL-11 Neumega Pfizer X X X 1-866-706-2400 www.rxpath.com Imatinib Gleevec Novartis X D,H,P,F X 1-800-245-5356 www.patientassistancenow.com Interferon alfa-2a Interferon H 1-800-675-8416 www.healthwellfoundation.org Interferon
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