ASSOCIATION OF COMMUNITY CANCER CENTERS This content is provided for informational purposes only and is not meant to substitute for medical advice, diagnosis, or treatment purposes. ACCC does not endorse or recommend any specific or any other information in this publication. The programs represented herein have been set up primarily by drug companies that offer free or low-cost drugs to insured, uninsured, or underinsured individuals who cannot afford their . Companies offer these programs voluntarily, and the government does not require the provision of free medicine. All content and links reflect accuracy on this date.

The ACCC Patient Assistance & Reimbursement Guide was updated starting November 2, 2020 and published online in January 2021. This publication is updated four times a year.

Visit accc-cancer.org/PatientAssistanceGuide to download and print the most up-to-date information on cancer drug assistance and reimbursement programs.

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 1 A Message from Jorge J. Garcia PharmD, MS, MHA, MBA, FACHE, ACCC Board of Trustees Member and OPEN Advisory Committee Member

This year ACCC is proud to publish the 10th print edition of its Patient Assistance & Reimbursement Guide. ACCC Immediate-Past President Ali McBride, PharmD, MS, BCOP, shared with us last year how cancer pro- grams and practices across the nation have expanded their financial advocacy efforts to include pharmacy and other supportive care staff as part of this critical patient service. Recognizing that our financial naviga- tion and pharmacy members are both “super-users” of this guide and the front-line staff responsible for helping patients with cancer overcome financial toxicity, ACCC made a thoughtful decision to more closely align its Patient Assistance & Reimbursement Guide with the ACCC Financial Advocacy Network (FAN) and the ACCC Oncology Pharmacy Education Network (OPEN). Leveraging color and branding—note the purple and orange hues long associated with the ACCC financial advocacy and pharmacy initiatives—and content, this year’s guide highlights the power of multidisciplinary care and the passion that cancer care teams have for treating our patients’ mind, body, and spirit.

As we head into a new year, we must also learn from our experiences in 2020 with the COVID-19 public health emergency. The impact of this pandemic is felt across all walks of life, especially among our frontline workers and our patients with cancer. Not only are our patients considered an at-risk population for getting COVID-19, but the country’s economic downturn as a result of the worldwide pandemic has taken a serious toll on these patients—regardless of their insurance coverage status. Many of our patients have lost their jobs and/or healthcare coverage, and they need financial assistance now more than ever. I want to take this time to thank all the financial navigators, financial counselors, pharmacy staff, social workers, and anyone else who has helped their patients receive the financial assistance they need.

For those new to financial advocacy, ACCC has updated its patient assistance flowchart (page 14) and developed a practical, step-by-step instruction to guide you as you help your patients access and pay for their cancer therapies. The article (pages 7-13) features members features members of the ACCC Financial Advocacy Network, who shared with us their experiences and workflows to help guide those new to finan- cial navigation.

I am also excited to share that ACCC has been hard at work looking to the future of this resource and how to best meet the changing needs of its members. Specifically, ACCC is exploring ways to create a robust and user-friendly digital Patient Assistance & Reimbursement Guide as a companion piece to the annual print edition—more news to come on this in 2021.

As the pace of drug approvals and the addition of novel agents increase exponentially, continual education and learning are needed. To help in this effort, the Patient Assistance & Reimbursement Guide is updated on a quarterly basis with the most updated information on cancer drug assistance and reimbursement programs, including directions on how to apply and links to enrollment forms. But we want your help! As you use this guide throughout the year, if you know of any changes, updates, and/or corrections to the information within, let us know. Please direct all comments, questions, comments, and feedback to Maddelynne Parker at [email protected].

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 1 ASSOCIATION OF COMMUNITY CANCER CENTERS

1 A Message from Dr. Jorge J. Garcia, ACCC Board of Trustees Member and OPEN Advisory Committee Member 7 Fighting Financial Toxicity: How Financial Navigators Help Patients with All Insurance Types By Teri Brown; Aimee Hoch, LSW; Jordan Karwedsky; Jennifer Paquet, RN, BSN; and Jeanie Troy

14 Financial Navigation Flowchart

Pharmaceutical Company Patient Sun Pharmaceutical Industries, Inc. 86 Assistance & Reimbursement Programs Taiho Oncology 88 AbbVie, Inc. 17 Takeda Oncology 90 , Inc. 18 TerSera Therapeutics 92 Astellas Pharma U.S., Inc. 20 Teva Oncology 93 AstraZeneca 23 Bayer HealthCare Pharmaceuticals, Inc. 25 Medical Device & Testing Patient BeiGene 29 Assistance & Reimbursement Programs Blueprint Medicines 30 Adaptive Biotechnologies 96 32 Foundation Medicine 97 Celgene Oncology 34 Coherus BioSciences 36 Other Patient Assistance Programs & Resources Daiichi Sankyo 37 Agingcare.com® 102 Daiichi Sankyo and AstraZeneca 39 AuntBertha.com 102 Eisai Co., Ltd. 41 BenefitsCheckUp® 102 43 CancerCare® 102 EMD Serono, Inc. 46 Cancer Financial Assistance Coalition 103 Epizyme, Inc. 48 Co-Pay Relief 103 Exelixis, Inc. 50 FamilyWize® 104 Genentech, Inc. 51 Good Days® 104 GlaxoSmithKline 53 HealthWell Foundation® 105 Immunomedics 55 The Leukemia & Lymphoma Society 105 Incyte Corporation 56 Medicine Assistance Tool 106 Ipsen Biopharmaceuticals, Inc. 58 Janssen Biotech, Inc. 60 NeedyMeds 106 Jazz Pharmaceuticals 62 Patient Access Network Foundation 107 Karyopharm Therapeutics 63 Patient Advocate Foundation 107 Kite Pharma 65 RxAssist 108 Merck 66 RxHope™ 108 MorphoSys 68 Rx Outreach® 108 Mylan 70 Quick Reference Guide 112 Pharmaceuticals Corporation 72 , Inc. 74 Pharmacyclics, LLC 76 The ACCC Patient Assistance & Reimbursement Guide was printed Regeneron Pharmaceuticals, Inc. and Genzyme 78 in January 2021. This publication is updated four times a year. Sandoz 80 Visit accc-cancer.org/PatientAssistanceGuide to download and Sanofi Genzyme 82 print the most up-to-date information on cancer drug assistance Seattle Genetics 84 and reimbursement programs.

2 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 3 Patient Assistance & Reimbursement Assistance Programs by drug or product

Abraxane® (paclitaxel protein-bound particles Gavreto™ () capsules 30 for injectable suspension) (albumin-bound) 34 Gazyva® (obinutuzumab) injection 51 Adakveo® (crizanlizumab-tmca) for IV infusion 72 Gleevec® ( mesylate) tablets 72 Adcetris® () for injection 84 Granix® (tbo-filgrastim) injection 93 Afinitor® () tablets 72 Halaven® (eribulin mesylate) injection 41 Alecensa® () capsules 51 Herceptin® () injection for intravenous use 51 Alimta® (pemetrexed) for injection 43 Herceptin Hylecta™ (hyaluronidase-oysk) injection 51 Aliqopa™ (copanlisib) for injection 25 Ibrance® () capsules 74 Alunbrig® () tablets 90 Iclusig® () tablets 90 Aranesp® (darbepoetin alfa) injection 18 Idamycin® (idarubicin hydrochloride) injections 74 Aromasin® (exemestane) tablets 74 Idhifa® () tablets 34 Avastin® () injection for IV use 51 Imbruvica® () capsules 76 Ayvakit™ () tablets 30 Imfinzi® (durvalumab) injection for intravenous use 23 Balversa™ () tablets 60 Imlygic® (talimogene laherparepvec) suspension Bavencio® (avelumab) injection 46 for injection 18 Bendeka® (bendamustine HCI) injection 93 Inlyta® () tablets 74 Besponsa® (inotuzumab ozogamicin) injection for IV infusion 74 Inqovi®(decitabine and cedazuridine) tablets 88 Blenrep (belantamab mafodotin-blmf) for injection 53 Inrebic® () capsules 34 Blincyto® (blinatumomab) for injection 18 Intron® A (interferon alfa-2b, recombinant) Bosulif® () tablets 74 for injection 66 Brukinsa™ (zanubrutinib) capsules 29 Iressa® () 23 Cabometyx® () tablets 50 Istodax® (romidepsin) for injection 34 Calquence® () capsules 23 Jadenu® (deferasirox) tablets 72 Camptosar® (irinotecan hydrochloride) injection 74 Jakafi® () tablets 56 Cometriq® (cabozantinib) capsules 50 Jevtana® (cabazitaxel) injection 82 Cotellic® () tablets 51 Kadcyla® (ado-) injection for intravenous use 51 Cyramza® (ramucirumab) injection 43 ™ Darzalex® (daratumumab) injection for intravenous infusion 60 Kanjinti (trastuzumab-anns) for injection 18 Darzalex Faspro™ (daratumumab and hyaluronidase-fihj) Keytruda® (pembrolizumab) injection 66 injection for subcutaneous use 60 Kisqali® (ribociclib) tablets 72 Daurismo™ (glasdegib) tablets 74 Kymriah® (tisagenlecleucel) suspension Defitelio® (defibrotide sodium) injection 62 for IV infusion 72 Elitek® (rasburicase) IV infusion 82 Kyprolis® (carfilzomib) for injection 18 Ellence® (epirubicin hydrochloride) injection 74 Lenvima® () capsules 41 Emend® (aprepitant) capsules 66 Libtayo® (cemiplimab-rwlc) injection 78 Emend® (fosaprepitant dimeglumine) for injection 66 Lonsurf® (trifluridine and tipiracil) tablets 88 Empliciti® (elotuzumab) for injection 32 Lorbrena® () tablets 74 Enhertu® (fam--nxki) injection for Lupron Depot® (leuprolide acetate for depot intravenous use 39 suspension) 17 Erbitux® () injection 43 Lynparza® (olaparib) tablets 23 Erleada® (apalutamide) tablets 60 Mekinist® () tablets 72 Erivedge® () capsules 51 Monjuvi®(tafasitamab-cxix) for injection 68 Erwineaze® (asparaginase Erwinia chrysanthemi) for injection 62 Mvasi™ (bevacizumab-awwb) injection 18 Exjade® (deferasirox) tablets for oral suspension 72 Mylotarg™ () for injection 74 Faslodex® (fulvestrant) injection 23 Neulasta® (pegfilgrastim) injection 18 Femara® (letrozole) tablets 72 Neulasta® Onpro® (pegfilgrastim) injection kit 18 Fulphila® (pegfilgrastim-jmdb) injection 70 Neupogen® (filgrastim) injection 18 Gardasil®9 (Human Papillomavirus 9-valent Vaccine, Recombinant) 66 Nexavar® () tablets 25

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 3 Patient Assistance & Reimbursement Assistance Programs by drug or product (continued)

Ninlaro® (ixazomib) capsules 90 Tecartus™ (brexucabtagene autoleucel) suspension for IV infusion 65 Nivestym® (filgrastim-aafi) injection 74 Tecentriq® (atezolizumab) injection for IV use 51 Nplate® (romiplostim) injection 18 Thalomid® (thalidomide) capsules 34 Nubeqa® (darolutamide) tablets 25 Torisel® () injection 74 Odomzo® () capsules 86 Trazimera™ (trastuzumab-qyyp) injection 74 Ogivri® (trastuzumab-dkst) injection 70 Treanda® (bendamustine hydrochloride) for injection 93 Onivyde® (irinotecan liposome injection) 58 Trisenox® (arsenic trioxide) injection 93 Onureg® (azacitidine) tablets 32 Trodelvy™ (sacituzumab govitecan-hziy) for injection 55 Opdivo® (nivolumab) injection for intravenous use 32 Tukysa® () tablets 84 Padcev™ (enfortumab vedotin-ejfv) injection for IV infusion 20 Turalio® () capsules 37 Perjeta® (pertuzumab) injection for intravenous use 51 Tykerb® () tablets 72 Pemazyre® () tablets 56 Udenyca® (pegfilgrastim-cbqv) 36 Piqray® (alpelisib) tablets 72 Varubi® (rolapitant) tablets 92 Polivy® (polatuzumab vedotin-piiq) injection for Vectibix® () for injection 18 intravenous use 51 Velcade® (bortezomib) for injection 90 Pomalyst® (pomalidomide) capsules 34 Venclexta® () tablets 51 Portrazza® (necitumumab) injection 43 Verzenio® (abemaciclib) tablets 43 Procrit® (epoetin alfa) injection 60 Vidaza® (azacitidine for injection) 34 Prolia® (denosumab) injection 18 Vitrakvi® () 25 Promacta® (eltrombopag) tablets 72 Vizimpro® () tablets 74 Reblozyl® (luspatercept-aamt) for injection 34 Votrient® () tablets 72 Retevmo™ () capsules 43 Vyxeos® (daunorubicin and cytarabine) liposome Revlimid® () capsules 34 for injection 62 Rituxan® () 51 Xalkori® () capsules 74 Rituxan Hycela® (rituximab/hyaluronidase human) Xgeva® (denosumab) injection 18 subcutaneous injection 51 Xofigo® (radium Ra 223 dichloride) injection 25 Rozlytrek® () capsules 51 Xospata® () tablets 20 Ruxience™ (rituximab-pvvr) injection 74 Xpovio® (selinexor) tablets 63 Rydapt® (midostaurin) capsules 72 Xtandi® (enzalutamide) capsules 20 Sandostatin® (octreotide acetate) injection 72 Yervoy® (ipilimumab) injection for intravenous use 32 Sandostatin® LAR Depot (octreotide acetate) Yescarta® (axicabtagene ciloleucel) suspension for injectable suspension 72 for IV infusion 65 Sarclisa® (isatuximab-irfc) injection for IV use 82 Yondelis® (trabectedin) for injection 60 Sensipar® (cinacalcet) tablets 18 Yonsa® (abiraterone acetate) tablets 86 Somatuline® Depot (lanreotide) injection 58 Zarxio® (filgrastim-sndz) subcutaneous or intravenous Sprycel® () tablets 32 injection 80 Stivarga® () tablets 25 Zejula® (niraparib) capsules 53 Sutent® ( malate) capsules 74 Zelboraf® () tablets 51 Synribo® (omacetaxine mepesuccinate) Zepzelca® (lurbinectedin) for injection 62 for injection 93 Ziextenzo® (pegfilgrastim-bmez) injection 80 Tabrecta™ () tablets 72 Zinecard® (dexrazoxane) injection 74 Tafinlar® () capsules 72 Zirabev™ (bevacizumab-bvzr) injection 74 Tagrisso® () tablets 23 Zoladex® (goserelin acetate implant) 92 Talzenna® (talazoparib) capsules 74 Zolinza® (vorinostat) capsules 66 Tarceva® () tablets 51 Zometa® (zoledronic acid) for injection 72 Tasigna® () capsules 72 Zykadia® () tablets 72 Tazverik® (tazemetostat) tablets 48 Zytiga® (abiraterone acetate) tablets 60

4 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 5 Patient Assistance & Reimbursement Assistance Programs by parenteral administration and oral administration

Parenteral Administration Keytruda® (pembrolizumab) injection 66 Abraxane® (paclitaxel protein-bound particles Kymriah® (tisagenlecleucel) suspension for injectable suspension) (albumin-bound) 34 for IV infusion 72 Adakveo® (crizanlizumab-tmca) for IV infusion 72 Kyprolis® (carfilzomib) for injection 18 Adcetris® (brentuximab vedotin) for injection 84 Libtayo® (cemiplimab-rwlc) injection 78 Alimta® (pemetrexed) for injection 43 Lupron Depot® (leuprolide acetate for depot suspension) 17 Aliqopa™ (copanlisib) for injection 25 Monjuvi® (tafasitamab-cxix) for injection 68 Aranesp® (darbepoetin alfa) injection 18 Mvasi™ (bevacizcmab-awwb) injection 18 Avastin® (bevacizumab) injection for IV use 51 Mylotarg™ (gemtuzumab ozogamicin) Bavencio® (avelumab) injection 46 for injection 74 Bendeka® (bendamustine HCI) injection 93 Neulasta® (pegfilgrastim) injection 18 Besponsa® (inotuzumab ozogamicin) injection for IV infusion 74 Neulasta® Onpro® (pegfilgrastim) injection kit 18 Blenrep (belantamab mafodotin-blmf) for injection 53 Neupogen® (filgrastim) injection 18 Blincyto® (blinatumomab) for injection 18 Nivestym® (filgrastim-aafi) injection 74 Camptosar® (irinotecan hydrochloride) injection 74 Nplate® (romiplostim) injection 18 Cyramza® (ramucirumab) injection 43 Ogivri® (trastuzumab-dkst) injection 70 Darzalex® (daratumumab) injection for intravenous use 60 Onivyde® (irinotecan liposome injection) 58 ™ Darzalex Faspro (daratumumab and hyaluronidase-fihj) Opdivo® (nivolumab) injection for intravenous use 32 injection for subcutaneous use 60 Padcev™ (enfortumab vedotin-ejfv) injection for IV use 20 Defitelio® (defibrotide sodium) injection 62 Perjeta® (pertuzumab) for injection for intravenous use 51 Elitek® (rasburicase) IV infusion 82 Polivy® (polatuzumab vedotin-piiq) injection for Ellence® (epirubicin hydrochloride) injection 74 intravenous use 51 Emend® (fosaprepitant dimeglumine) for injection 66 Portrazza® (necitumumab) injection 43 Empliciti® (elotuzumab) for injection 32 Procrit® (epoetin alfa) injection 60 Enhertu®(fam-trastuzumab deruxtecan-nxki) injection for Prolia® (denosumab) injection 18 intravenous use 39 Reblozyl® (luspatercept-aamt) for injection 34 Erbitux® (cetuximab) injection 43 Rituxan® (rituximab) 51 Erwineaze® (asparaginase Erwinia chrysanthemi) for injection 62 Rituxan Hycela® (rituximab/hyaluronidase human) Faslodex® (fulvestrant) injection 23 injection for subcutaneous use 51

Fulphila® (pegfilgrastim-jmdb) injection 70 ™ Ruxience (rituximab-pvvr) injection 74 Gardasil®9 (Human Papillomavirus 9-valent Sandostatin® (octreotide acetate) injection 72 Vaccine, Recombinant) 66 Sandostatin® LAR Depot (octreotide acetate) Gazyva® (obinutuzumab) injection 51 for injectable suspension 72 Granix® (tbo-filgrastim) injection 93 Sarclisa® (isatuximab-irfc) injection for IV use 82 Halaven® (eribulin mesylate) injection 41 Somatuline® Depot (lanreotide) injection 58 Herceptin® (trastuzumab) injection for intravenous use 51 Synribo® (omacetaxine mepesuccinate) Herceptin Hylecta™ (trastuzumab and for injection 93 hyaluronidase-oysk) injection 51 ™ Tecartus (brexucabtagene autoleucel) suspension Idamycin® (idarubicin hydrochloride) injection 74 for IV infusion 65 Imfinzi® (durvalumab) injection for intravenous use 23 Tecentriq® (atezolizumab) injection for IV use 51 Imlygic® (talimogene laherparepvec) suspension Torisel® (temsirolimus) injection 74 for injection 18 Trazimera™ (trastuzumab-qyyp) injection 74 Intron® A (interferon alfa-2b, recombinant) Treanda® (bendamustine hydrochloride) for injection 93 for injection 66 Trisenox® (arsenic trioxide) injection 93 Istodax® (romidepsin) for injection 34 Trodelvy™ (sacituzumab govitecan-hziy) for injection 55 Jevtana® (cabazitaxel) injection 82 Udenyca® (pegfilgrastim-cbqv) 36 Kadcyla® (ado-trastuzumab emtansine) injection for intravenous use 51 Vectibix® (panitumumab) for injection 18 Kanjinti™ (trastuzumab-anns) for injection 18 Velcade® (bortezomib) for injection 90

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 5 Patient Assistance & Reimbursement Assistance Programs by parenteral administration and oral administration (continued)

Vidaza® (azacitidine for injection) 34 Lenvima® (lenvatinib) capsules 41 Vyxeos® (daunorubicin and cytarabine) liposome for injection 62 Lonsurf® (trifluridine and tipiracil) tablets 88 Xgeva® (denosumab) injection 18 Lorbrena® (lorlatinib) tablets 74 Xofigo® (radium Ra 223 dichloride) injection 25 Lynparza® (olaparib) tablets 23 Yervoy® (ipilimumab) injection for intravenous use 32 Mekinist® (trametinib) tablets 72 Yescarta® (axicabtagene ciloleucel) suspension Nexavar® (sorafenib) tablets 25 for IV infusion 65 Ninlaro® (ixazomib) capsules 90 Yondelis® (trabectedin) 60 Nubeqa® (darolutamide) tablets 25 Zarxio ®(filgrastim-sndz) subcutaneous or intravenous Odomzo® (sonidegib) capsules 86 injection 80 Onureg® (azacitidine) tablets 32 Zepzelca® (lurbinectedin) for injection 62 Pemazyre® (pemigatinib) tablets 56 Ziextenzo® (pegfilgrastim-bmez) injection 80 Piqray® (alpelisib) tablets 72 Zinecard® (dexrazoxane) for injection 74 Pomalyst® (pomalidomide) capsules 34 ™ Zirabev (bevacizumab-bvzr) injection 74 Promacta® (eltrombopag) tablets 72 Zoladex® (goserelin acetate implant) 92 Retevmo™ (selpercatinib) capsules 43 Zometa® (zoledronic acid) for injection 72 Revlimid® (lenalidomide) capsules 34 Rozlytrek® (entrectinib) capsules 51 Oral Administration Rydapt® (midostaurin) capsules 72 Afinitor® (everolimus) tablets 72 Sensipar® (cinacalcet) tablets 18 Alecensa® (alectinib) capsules 51 Sprycel® (dasatinib) tablets 32 Alunbrig® (brigatinib) tablets 90 Stivarga® (regorafenib) tablets 25 Aromasin® (exemestane) tablets 74 Sutent® (sunitinib malate) capsules 74 Ayvakit™ (avapritinib) tablets 30 Tabrecta™ (capmatinib) tablets 72 Balversa™ (erdafitinib) tablets 60 Tafinlar® (dabrafenib) capsules 72 Bosulif® (bosutinib) tablets 74 Tagrisso® (osimertinib) tablets 23 Brukinsa™ (Zanubrutinib) capsules 29 Talzenna® (talazoparib) capsules 74 Cabometyx® (cabozantinib) tablets 50 Tarceva® (erlotinib) tablets 51 Calquence® (acalabrutinib) capsules 23 Tasigna® (nilotinib) capsules 72 Cometriq® (cabozantinib) capsules 50 Tazverik® (tazemetostat) tablets 48 Cotellic® (cobimetinib) tablets 51 Thalomid® (thalidomide) capsules 34 Daurismo™ (glasdegib) tablets 74 Tukysa® (tucatinib) tablets 84 Emend® (aprepitant) capsules 66 Turalio® (pexidartinib) capsules 37 Erleada® (apalutamide) tablets 60 Tykerb® (lapatinib) tablets 72 Erivedge® (vismodegib) capsules 51 Varubi® (rolapitant) tablets 92 Exjade® (deferasirox) tablets for oral suspension 72 Venclexta® (venetoclax) tablets 51 Femara® (letrozole) tablets 72 Verzenio® (abemaciclib) tablets 43 ™ Gavreto (pralsetinib) capsules 30 Vitrakvi® (larotrectinib) 25 Gleevec® (imatinib mesylate) tablets 72 Vizimpro® (dacomitinib) tablets 74 Ibrance® (palbociclib) 74 Votrient® (pazopanib) tablets 72 Iclusig® (ponatinib) tablets 90 Xalkori® (crizotinib) capsules 74 Idhifa® (enasidenib) tablets 34 Xospata® (gilteritinib) tablets 20 Imbruvica® (ibrutinib) capsules 76 Xpovio® (selinexor) tablets 63 Inqovi®(decitabine and cedazuridine) tablets 88 Xtandi® (enzalutamide) capsules 20 Inrebic® (fedratinib) capsules 34 Yonsa® (abiraterone acetate) tablets 86 Inlyta® (axitinib) tablets 74 Zejula® (niraparib) capsules 53 Iressa® (gefitinib) 23 Zelboraf® (vemurafenib) tablets 51 Jadenu® (deferasirox) tablets 72 Zolinza® (vorinostat) capsules 66 Jakafi® (ruxolitinib) tablets 56 Zykadia® (ceritinib) tablets 72 Kisqali® (ribociclib) tablets 72 Zytiga® (abiraterone acetate) tablets 60

6 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 7 ASSOCIATION OF COMMUNITY CANCER CENTERS cial Navigator inan s F nts with All ow atie Insu H p P ra el nc H e Ty p e s

By Teri Brown Aimee Hoch, LSW Jordan Karwedsky Jennifer Paquet, RN, BSN and Jeanie Troy

Cancer is one of the costliest diseases to treat in the United States. According to a 2019 survey conducted by The Mesothelioma Center, 63 percent of patients with cancer and their caregivers struggle financially following a cancer diagnosis.1 This struggle often continues long after patients’ initial diagnosis into treatment, and it can follow them into survivorship and follow-up care. As the cost of treatment continues to rise, the financial burden that often accompanies a cancer diagnosis is growing to unsustainable levels—the cost of new cancer tops the charts at $100,000 or higher annually.2

As health insurers continue to shift these growing costs We are seeing the ever-increasing cost of care, com- to patients, they result in higher deductibles, co-pays, pounded by the COVID-19 pandemic, not only affecting and co-insurance amounts for cancer therapies, our patients’ ability to access and pay for their treat- depending on the insurance plan.3 The COVID-19 pan- ment, but also their ability to afford the costs of daily demic only increased the financial burden on patients, living, including rent, groceries, and transportation. As as unemployment and loss of health insurance affect financial navigators, we are in a unique position to help more and more people. According to a survey con- ease patients’ financial burden of care. Our skill set ducted in March 2020 by the American Cancer Society allows us to serve patients before we even meet them. Action Network, 50 percent of the 1,200 patients and Armed with patients’ individual insurance and financial survivors surveyed report that COVID-19 has impacted information, we can get a head start on formulating a their healthcare.4 The same survey also found that 27 plan that can help patients access the treatment they percent of the patients in active treatment had to delay need, eliminating or reducing the financial toxicity that treatment due to the pandemic.4 too often accompanies life-saving cancer care.

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 7 Financial Advocacy Programs Meet Patient Needs In response to an ACCC Financial Advocacy Network who has a role in providing patients financial navigation survey of ACCC’s member cancer programs in late services. Financial navigation programs can vary signifi- 2019, 10 percent of respondents (292 people from cantly based on their rural or urban setting and whether 153 unique cancer programs) report that their cancer they are community cancer programs or affiliated with program employs no financial advocates. Asked if an academic institution. respondents have enough full-time staff to meet the demand for financial advocacy services, 36 percent of This guide helps financial navigators who may be survey respondents said they do not, and 34 percent new to their role assist patients with varying insur- replied, “not always.” Of those practices that do have ance status access and afford their prescribed cancer financial advocates on staff, the majority (60 percent) treatment therapies. In the end, we want our patients employ just one to three advocates.5 In some cancer and their families to focus on their health and not programs, social workers, pharmacists, or other support- let their finances be a determinant of the care they ive care staff—in addition to their other duties—provide receive. Here, we present potential approaches to financial navigation services to patients. In this guide, help patients afford their cancer care according to financial advocates are defined as any staff member their insurance status.

Patients with Commercial Insurance

Jordan Karwedsky is a financial counselor patients’ finances can be a tricky situation to navigate at Green Bay Oncology in Green Bay, because they are not always willing to share their per- Wisconsin. Karwedsky is also a member sonal financial information with someone they do not of the ACCC Financial Advocacy Network’s know. It is therefore important as a financial counselor Network Task Force and the ACCC Patient to build the foundation of a trusting relationship with Assistance & Reimbursement Guide your patients from the start. Patients will not likely know Task Force. their financial options. I have found that many patients are unaware that co-pay assistance programs exist. Always take a proactive approach with patients who Many of them want to know, “What’s the catch?” It is need co-pay assistance, regardless of their insur- important to explain to these patients what indepen- ance type. At Green Bay Oncology, when a patient is dent foundations and manufacturer co-pay programs commercially insured or has an employer-based plan, are, how each works, and what information is needed financial counselors review and discuss with patients to determine patients’ eligibility—in terms that they their insurance coverage and annual out-of-pocket understand. I have found it helpful to compare co-pay maximum at their initial consult, so we can begin to cards to the coupons patients use at a grocery store. address any financial concerns up front. While obtain- ing insurance authorizations for treatment, we also There will always be some patients who will say before determine if patients need assistance with their copay- beginning treatment that they are not interested ment, coinsurance, or deductible. Difficulty affording in co-pay assistance, saying they prefer assistance cancer treatments may be eased by accessing funds programs to go to someone who needs it more than from independent foundations or drug manufactur- they do. Always be sure to follow back up with these ers’ co-pay card programs. We follow up with patients patients a month or two into their treatment plan to at their education or initial treatment make sure they are doing okay financially and to help appointmentchemotherapy educatioy assistance if they now want to access a co-pay program or other options that may be available to them. Discussing assistance.

8 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 9 Patients with Medicare or Who Are Medicare Eligible

Jennifer Paquet, RN, BSN, is a financial When I first started working as a financial navigator, I navigator at Bassett Healthcare in was afraid of appearing too invasive when asking for Cooperstown, New York and is an patients’ personal information. I have since learned ACCC Financial Advocacy Network that when you take time with patients to explain that Workforce Task Force Member you work for them rather than an insurance company, you are pleasantly surprised by how comfortable they Often, new Medicare recipients are sold are giving you the information you need to help them. on low-cost Medicare Advantage plans that feature Assure patients that receiving treatment does not have lower monthly premiums, relatively inexpensive co-pays, to be a choice. There is always a solution. Sometimes and reduced prescription drug prices. While this may the solution is not easy to find, but it is there. be appealing to newly retired Americans, they are often not told when choosing their first Medicare Advantage Be Prepared plan that they will incur higher costs if they are diag- Once you know what type of Medicare plan patients nosed with a long-term, costly disease, like cancer. have or if they do not have additional coverage, help them explore other potential insurance options. If an Choosing an insurance plan is daunting. Many Medicare insurance change is an option, whether to a federally recipients do not even open the Medicare & You hand- funded plan or to include additional coverage, make book they receive from the Centers of Medicare & Med- these options available in customized packets you can icaid Services each year. Some say this handbook is not present to patients. This packet may include a Medicare written in a language they understand. This is where a Savings Program application and any other state pro- financial navigator’s expertise comes in. We break down grams for which patients may qualify. For patients with the language of insurance options for our patients and Medicare only, it is imperative to get those patients on make it clear and relevant to them. Financial navigators a supplemental plan with a short waiting period (e.g., explain to patients how a given plan works and why the three months or less). plan works that way. This education allows patients to better understand the details of the plan they choose. For patients who qualify for income-based assistance, I include a list of independent foundations with open Meeting New Patients funding. These organizations may help offset out- As important as it is to educate patients about their of-pocket cost for medications. (Aimee Hoch, LSW, insurance options as soon as possible after diagnosis, explains more on how to help your patients with Medi- be careful not to approach patients until after they first care and commercial insurance access co-pay and out- meet with their cancer care team. It is vital that patients of-pocket cost assistance from independent foundations first understand the nature of their disease state before on page 10.) Easing the burdens of household bills they are approached by financial navigators to help helps just as much as mitigating medical costs. By allevi- them through the financial side of cancer treatment. ating the expenses of daily living, you free up resources for meeting medical expenses. Financial assistance When I first meet with patients, I review their benefits programs are found in many places. Reach out to social investigation with them and answer any questions they workers in your community, your local department of have about paying for their care. At this initial meeting social services, churches, American Legion halls, etc. with patients, try to obtain as much information as you You will be surprised by the number of groups that are can. Do not be afraid to ask patients the following: out there waiting to help patients. 1. What is your household income? 2. What are your household expenses? I store all this information on my computer and in our 3. What do you pay for your current healthcare electronic medical record. I always have available to insurance plan?

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 9 me patient release of information forms, so I have My very last words to every single patient I see are, “You access to all of the information necessary to help worry about getting through this, and I will worry about individual patients apply for funding, free medica- the money.” I can never stress enough how very import- tions, and foundational help when these resources ant it is to treat each patient with compassion, laughter, are available. empathy, and love. Be passionate and kind; make sure patients know you are only a phone call away, that you are their financial advocate, and that they matter.

Patients with Medicare or Commercial Insurance Foundation Co-Pay Assistance Programs

Aimee Hoch, LSW, is an oncology 2. Obtain permission during the initial assessment. financial navigator at Grand View Health in Sellersville, Pennsylvania and an ACCC Foundation funds open and close very quickly, so Financial Advocacy Network Advisory having the correct patient information and permission Committee member. ahead of time allows you to act fast to apply for co-pay assistance when it becomes available. During my Knowing what co-pay assistance each patient needs initial consultation with patients, I take time to educate and where to find it—often in short order—is key to them about their co-pay assistance options, determine successfully securing funding and ultimately creating whether they may qualify for and benefit from foun- access to necessary treatment. These four key steps can dational assistance, and obtain their permission to help financial navigators provide patients access to the act on their behalf if a foundation fund that supports co-pay assistance they qualify for from various inde- their disease and status should open. In most cases, I pendent foundations. These organizations offer co-pay refer Medicare recipients to foundational assistance. assistance and may offer insurance premium assistance However, patients with commercial insurance may also and/or some travel assistance. benefit from foundational assistance if they qualify.

1. Always have up-to-date knowledge 3. Streamline the application process. of open funds. When I first became a financial navigator, one of my One of the most important steps in accessing co-pay immediate tasks was to set up my account and/or personal assistance via independent foundations is knowing portal with each foundation I track. These accounts and when funds are available. I enrolled in the Patient Access online portals allow me to act fast before foundation Network’s FundFinder, which is a great tool for helping funds close. Most foundations make staff available by me track this information. I also monitor the availability phone to help with this registration, if necessary. of disease-specific funds from various foundations, and 4. Organize a spreadsheet or list of patients. I receive alerts on my phone and through email in real time. I also signed up for each foundations’ email news- Keeping patient information in an organized spread- letter and receive notifications of all open funds a single sheet or list helps you stay on top of things when foundation has. This may seem like it will fill up your applying for assistance or renewing assistance for inbox, but it is the best way to stay on top of the avail- patients. My spreadsheet includes new and current ability of funds from numerous foundations. I make sure patients waiting for foundation funds to open, as well as I receive a notification any time a fund with a foundation the patients currently enrolled with foundations and the is made available, so I can apply for assistance on behalf dates indicating when it is time to reapply for assistance of patients who qualify. on their behalf.

10 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 11 Patients Without Insurance Who Are Medicaid Eligible

Teri Brown is a financial navigator at receive Medicaid immediately, and they are given a Kettering Cancer Care in Kettering, Ohio. billing number. This enables patients to receive full healthcare services, including hospital, physician, I help patients who come to us dental, and eye care. Once our patients are granted to pay for their cancer therapies this interim coverage, we help them complete a full out-of-pocket or when uninsured and Medicaid application that is reviewed by the local who qualify for Medicaid. Over 32 years, I worked in county office. The patient story below illustrates the the Greene County Department of Job and Family value financial navigators bring to patients: Services in Xenia, Ohio, which gave me experience and in-depth knowledge of Ohio’s Medicaid program. I spoke with a young man who was diagnosed I have since taught other financial navigators at Ket- with lymphoma. He did not have any source of tering Cancer Care the ins and outs of Ohio’s Med- income or insurance. He also told me that he had icaid program and how to help patients with limited previously applied for Medicaid but was denied. resources apply to Medicaid to pay for life-saving As I spoke to this patient, I learned that he is the cancer treatment. Patients come to our financial father of two small children. The mother of the navigation program through many pathways: children had both children signed up for Medic- self-referral or through referrals from various aid under her name, making her Medicaid-eligible members of the cancer care team, including our as well. I then asked the patient about his rela- social workers, nurses, physicians, pre-certification tionship with the children’s mother. He said it staff, and schedule review staff. was “very good” and that they share parenting responsibilities. I let him know that, with shared Once we determine that patients are not commer- parenting, both he and his children’s mother cially insured and are eligible for Medicaid, our finan- could place one of their children on Medic- cial navigators contact them to discuss the circum- aid under their name, which would allow both stances leading up to their loss of insurance. After parents to also be eligible for Medicaid. After speaking to patients, financial navigators complete this conversation, the patient spoke to the chil- an online presumptive Medicaid application through dren’s mother, and she agreed to remove one the state of Ohio on the patients’ behalf. This allows of the children from her Medicaid coverage, so our patients to be eligible for Medicaid coverage for my patient could enroll one of his children and up to three months on an emergency basis until the qualify for coverage himself. The applications Ohio Department of Job and Family Services reviews were approved, and the patient is now able to their case. Most patients are usually approved to receive all hospital services without worry.

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 11 Patients Without Insurance Who Are Not Eligible for Medicare or Medicaid Drug Manufacturer Patient Assistance Programs

Jeanie Troy is a patient financial navigator website, you can download the patient assistance at Lake Region Healthcare, Cancer Care program application or complete it online. and Research Center in Fergus Falls, Minnesota and is an ACCC Financial I then complete the application with the patient and Advocacy Network Workforce Task collect any necessary supporting documents, such as Force member. income verification, to send to the manufacturer’s patient assistance program. From my experience, it takes on When I receive a new patient notification for an unin- average one to two weeks to receive an approval. Some sured patient, my first task is to determine if they are eli- programs will send the prescribed medication directly gible for Medicaid or to purchase commercial insurance to our facility before the patient starts treatment, while in the case of a recent life-changing event. If a patient is others replace the medication used from our pharmacy not eligible for insurance coverage, I make their pro- after the patient completes each treatment. vider aware that the patient is uninsured before their first consult with their cancer care team. If I am unable to identify a manufacturer patient assis- tance program for a given medication, I investigate Once a provider establishes a patient’s treatment plan, independent foundations that may be able to offer they will notify me through our electronic health record, support to cover treatment costs. If there is available so I can begin looking for patient assistance programs funding from a foundation, I complete the application for which the patient may be eligible. Our facility now for the patient and submit it for consideration. uses a third-party program to help us streamline the financial navigation process. Before we had this great The last task I do is help that patient apply for assistance tool, I would usually search the ACCC Patient Assistance through the Community Care program at Lake Region & Reimbursement Guide or Google the prescribed Healthcare. Through Community Care, patients may be medication’s name followed by “patient assistance eligible to have part or all their remaining balance written program” (i.e., “Keytruda patient assistance program”). off based on their household size and income. If a patient From the medication’s manufacturer owes any balance beyond that, I work with them to set up an affordable payment plan that works for them.

Patients with Other Government-Funded Programs (e.g., VA, DOD, TriCare)

Patients’ whose insurance is funded by the federal prescribed medications, they may have to pay a co-pay government but is not Medicare—Veterans Affairs (VA), to have the prescriptions filled at another pharmacy. Department of Defense (DOD), and TriCare, among others—usually receive their prescribed oncology medi- Unfortunately, patients in this population are not usually cations for free. With every program, you must submit a eligible for financial assistance to cover the costs of prior authorization for each medication. Once the prior their medications because their insurance should cover authorization is complete, insurance should cover the the entire cost. But patients with government-funded entire cost of the prescribed medication. insurance may qualify for independent charitable foundations that can help with daily living expenses, like TriCare has the only exception. If patients covered by mortgage/rent payments, monthly bills, groceries, travel TriCare are out of range of a VA pharmacy to pick up their costs, and more.

12 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 13 Caring for the Caregiver has developed some great resources to help you build resiliency and a self-care routine. Examples include the Financial navigators must practice self-care. Find time CANCER BUZZ podcast, “Fostering Cancer Care Team in your day or after work to be mindful and do what Resiliency & Well-Being” and the ACCCBuzz article, you need to do to decompress from your day. ACCC “Taking Care in a Pandemic”.

References

1. The Mesothelioma Center. High cost of cancer 4. The American Cancer Society Cancer Action treatment. www.asbestos.com/featured-stories/ Network. COVID-19 pandemic impact on cancer high-cost-of-cancer-treatment/. Last accessed patients and survivors: survey findings summary. October 20, 2020. https://www.fightcancer.org/policy-resources/covid- 19-pandemic-early-effects-cancer-patients-and- 2. Rimer BK. The imperative of addressing cancer survivors-april-2020. Last accessed drug costs and value. https://www.cancer.gov/ October 20, 2020. news-events/cancer-currents-blog/2018/presi- dents-cancer-panel-drug-prices. Last accessed 5. Association of Community Cancer Centers Financial November 11, 2020. Advocacy Network. Advocating amid a crisis: the expanding role of financial advocates in the 3. Shwartz K, Claxton G, Martin K, Schmidt C. age of COVID-19. www.accc-cancer.org/docs/ Spending to survive: cancer patients confront documents/oncology-issues/articles/so20/so20- holes in the health insurance system. https:// advocating-amid-a-crisis.pdf?sfvrsn=74bc39ef_7. www.kff.org/wp-content/uploads/2013/01/7851 Last accessed October 20, 2020. .pdf. Last accessed November 11, 2020.

The ACCC Financial Advocacy Network is the leader in providing professional development training, tools, and resources that will empower providers to proactively integrate financial health into the cancer care continuum and help patients gain access to high-quality care for a better quality of life. Access an abundance professional development and educational resources for financial advocates at accc-cancer.org/FAN.

The ACCC Oncology Pharmacy Education Network advocates on behalf of hematology-oncology pharmacists as vital members of the cancer care team and is committed to developing educational resources and multidisciplinary connections that advance the field and elevate oncology pharmacy professionals to top-of-license practice. Explore our library of digital and print content at accc-cancer.org/OPEN.

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 13 Financial Navigation Flowchart

STEP 1. STEP 2. STEP 3. Provider prescribes Anti-cancer medication(s) Finanical advocacy staff identify the patients’ anti-cancer treatment order is sent to financial financial status/insurance type(s) and follows regimen for patient. advocacy staff. the appropriate workflow below.

Identify if patient qualifies for If no program, identify if replacement medi- If no program is identified Complete and submit If applicable, identify if patient qualifies Establish a payment plan Follow up with patient at any state or federal program cation(s) is available. Check with the pharma- in step 1, look for foundation identified foundation for charity care within the cancer program/ for any leftover balance regular intervals during No Insurance (i.e., Medicare, Medicaid, etc.). ceutical company to see if they have a free funding available for any program application form(s), practice or healthcare system. Complete (if available) or collect treatment. Complete and submit all forms medication program or even a compassionate medication(s) not replaced. if available. and submit this paperwork. remaining balance. for identified program. use program.

Verify benefits. Verify prescribed medication(s) are approved/indicated for Identify patient’s responsibility Identify if replacement medication(s) is available, if neces- Complete and submit Collect Follow up with patient at Medicaid diagnosis/place in therapy and submit pre-determination or for prescribed medication(s). sary; may also be able to file for compassionate use with identified program out-of-pocket regular intervals during Program prior authorization, if necessary. pharmaceutical company to receive medication(s). application form(s). costs. treatment.

Verify bene- Verify if patient If patient is retiring If patient will retain bene- If patient is not retaining Look at patient’s treatment plan and associated medica- Complete and submit Establish a payment plan Follow up with patient Medicare: fits: does is retiring soon; soon and has Part fits, their plan may not an employer-funded tion(s); find free-medication program or reimbursement identified program for any left over balance at regular intervals Eligible the patient will their current A only, have they require Medicare Part retirement plan, go over plan, if available; may also be able to file for compas- application form(s). (if available) or collect the during treatment. (Age 65/Retired/ have Part A benefits be applied for Part B? B. Check with patient if insurance plans available sionate use with pharmaceutical company to receive remaining balance. Disabled) only or Parts retained? Provide paperwork, if employer-funded plan to them (i.e., supplemen- medication(s). A and B? applicable. requires Part B. tals and advantage plans).

Verify benefits. Verify length of time patient has Identify if patient is eligible for If not eligible, look Look at plans Look at patient’s treatment plan and associated Complete and submit Establish a payment plan Medicare: been on Medicare and length of Medicaid or Medicare Secondary at Medicare supple- if patient does not already medication(s); find free-medication program or identified program for any left over balance Part A and/or B Only gap in insurance coverage Payer plan. If so, help patient mental plan with a have this coverage. reimbursement plan, if available; may also be application form(s). (if available) or collect the (Age 65/Retired/ (this will determine Part D penalty). complete and submit applicable short waiting period able to file for compassionate use with phar- remaining balance. Disabled) form(s). (3 months max). maceutical company to receive medication(s).

Verify benefits. Look at patient’s treatment Identify if patient is eligible for Go over insurance plan with If an insurance change is not available, Complete and submit If any balance, establish a payment Follow up with patient at Medicare: plan and associated medi- Medicaid or a Medicare Supple- patient; identify where they identify if foundation assistance is available. identified program plan for any left over balance (if regular intervals during Age 65 and retired cation(s); find free-medica- mental Payer plan. If so, help can save dollars (i.e., changing May also be able to file for compassionate application form(s). available) or collect remaining treatment. with a Medicare tion program or reimburse- patient complete and submit insurance, if applicable). use with pharmaceutical company to receive balance. Supplemental Plan ment plan, if available. applicable form(s). medication(s).

Medicare: Verify benefits. Go over insurance plan with patient; If changing back to Medicare, add a Part D plan Look at patient’s treatment plan and associated medica- Complete and submit If any balance, establish a Follow up with Advantage Plan identify where they can save dollars (i.e., and supplemental plan. If changing Advantage tion(s); find free-medication program or foundation, if identified program payment plan for any left patient at regular (Age 65/Retired/ changing insurance, if applicable). Plan, make sure you meet the criteria to change available; may also be able to file for compassionate use application form(s). over balance (if available) or intervals during Disabled) or are in open enrollment period. with pharmaceutical company to receive medication(s). collect remaining balance. treatment.

Verify benefits. Verify prescribed medication(s) are Identify patient’s respon- If patient has TriCare and is Identify if free medication(s) is Patients in this population are not usually Complete and If any balance, Follow up Other approved/indicated for diagnosis/ sibility for prescribed out of range of a Veterans available, if necessary; complete eligible for financial assitance, including submit identified establish a payment with patient Government place in therapy and submit prior medication(s). In rare Affairs pharmacy to pick and submit applicable form(s); manufacturer assistance. To help offset independent plan for any left over at regular Programs authorization. A prior authorization is instances, patients may up their prescription, then may also be able to file for costs, look for independent foundational foundation balance (if available) intervals (e.g., VA, DOD, necessary. have a co-pay. patients may have a co-pay. compassionate use with phar- assistance that can provide assistance with program appli- or collect remaining during TriCare) maceutical company to receive groceries, mortgage/rent payments, vehicle cation form(s). balance. treatment. medication(s). payments, monthly bills, etc.

Verify benefits. Verify prescribed medica- Identify Identify if free Identify if manufacturer If no manufactuer Complete and If patient qualifies for Process payment If any balance, Follow up tion(s) are approved/indi- patient’s medication(s) assistance is available and assistance is avail- submit identi- manufactuer or foundation using the co-pay establish a payment with patient Commercial cated for diagnosis/place responsi- is available, complete and submit applicible able, identify if foun- fied program assistance, send an explana- card or other form plan for any left over at regular & Insurance in therapy and submit bility for if necessary; form(s); may also be able to file dation assistance is application tion of benefits (EOB) and/ of payment the balance (if available) intervals Exchanges pre-determination prescribed complete and for compassionate use with available. form(s). or other paperwork to verify identified program or collect remaining during (Managed Care) or prior authorization medica- submit appli- pharmaceutical company to amount owed. offers. balance. treatment. if necessary. tion(s). cable form(s). receive medication(s).

14 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 15 ACCC graciously thanks Wendy Andrews, practice Financial Navigation Flowchart administrator at University of Arizona Cancer Center, for creating this flowchart, and the ACCC Patient Assistance & Reimbursement Guide Task Force and ACCC Financial Advocacy Network members for their edits and updates.

Identify if patient qualifies for If no program, identify if replacement medi- If no program is identified Complete and submit If applicable, identify if patient qualifies Establish a payment plan Follow up with patient at any state or federal program cation(s) is available. Check with the pharma- in step 1, look for foundation identified foundation for charity care within the cancer program/ for any leftover balance regular intervals during (i.e., Medicare, Medicaid, etc.). ceutical company to see if they have a free funding available for any program application form(s), practice or healthcare system. Complete (if available) or collect treatment. Complete and submit all forms medication program or even a compassionate medication(s) not replaced. if available. and submit this paperwork. remaining balance. for identified program. use program.

Verify benefits. Verify prescribed medication(s) are approved/indicated for Identify patient’s responsibility Identify if replacement medication(s) is available, if neces- Complete and submit Collect Follow up with patient at diagnosis/place in therapy and submit pre-determination or for prescribed medication(s). sary; may also be able to file for compassionate use with identified program out-of-pocket regular intervals during prior authorization, if necessary. pharmaceutical company to receive medication(s). application form(s). costs. treatment.

Verify bene- Verify if patient If patient is retiring If patient will retain bene- If patient is not retaining Look at patient’s treatment plan and associated medica- Complete and submit Establish a payment plan Follow up with patient fits: does is retiring soon; soon and has Part fits, their plan may not an employer-funded tion(s); find free-medication program or reimbursement identified program for any left over balance at regular intervals the patient will their current A only, have they require Medicare Part retirement plan, go over plan, if available; may also be able to file for compas- application form(s). (if available) or collect the during treatment. have Part A benefits be applied for Part B? B. Check with patient if insurance plans available sionate use with pharmaceutical company to receive remaining balance. only or Parts retained? Provide paperwork, if employer-funded plan to them (i.e., supplemen- medication(s). A and B? applicable. requires Part B. tals and advantage plans).

Verify benefits. Verify length of time patient has Identify if patient is eligible for If not eligible, look Look at Medicare Part D plans Look at patient’s treatment plan and associated Complete and submit Establish a payment plan been on Medicare and length of Medicaid or Medicare Secondary at Medicare supple- if patient does not already medication(s); find free-medication program or identified program for any left over balance gap in insurance coverage Payer plan. If so, help patient mental plan with a have this coverage. reimbursement plan, if available; may also be application form(s). (if available) or collect the (this will determine Part D penalty). complete and submit applicable short waiting period able to file for compassionate use with phar- remaining balance. form(s). (3 months max). maceutical company to receive medication(s).

Verify benefits. Look at patient’s treatment Identify if patient is eligible for Go over insurance plan with If an insurance change is not available, Complete and submit If any balance, establish a payment Follow up with patient at plan and associated medi- Medicaid or a Medicare Supple- patient; identify where they identify if foundation assistance is available. identified program plan for any left over balance (if regular intervals during cation(s); find free-medica- mental Payer plan. If so, help can save dollars (i.e., changing May also be able to file for compassionate application form(s). available) or collect remaining treatment. tion program or reimburse- patient complete and submit insurance, if applicable). use with pharmaceutical company to receive balance. ment plan, if available. applicable form(s). medication(s).

Verify benefits. Go over insurance plan with patient; If changing back to Medicare, add a Part D plan Look at patient’s treatment plan and associated medica- Complete and submit If any balance, establish a Follow up with identify where they can save dollars (i.e., and supplemental plan. If changing Advantage tion(s); find free-medication program or foundation, if identified program payment plan for any left patient at regular changing insurance, if applicable). Plan, make sure you meet the criteria to change available; may also be able to file for compassionate use application form(s). over balance (if available) or intervals during or are in open enrollment period. with pharmaceutical company to receive medication(s). collect remaining balance. treatment.

Verify benefits. Verify prescribed medication(s) are Identify patient’s respon- If patient has TriCare and is Identify if free medication(s) is Patients in this population are not usually Complete and If any balance, Follow up approved/indicated for diagnosis/ sibility for prescribed out of range of a Veterans available, if necessary; complete eligible for financial assitance, including submit identified establish a payment with patient place in therapy and submit prior medication(s). In rare Affairs pharmacy to pick and submit applicable form(s); manufacturer assistance. To help offset independent plan for any left over at regular authorization. A prior authorization is instances, patients may up their prescription, then may also be able to file for costs, look for independent foundational foundation balance (if available) intervals necessary. have a co-pay. patients may have a co-pay. compassionate use with phar- assistance that can provide assistance with program appli- or collect remaining during maceutical company to receive groceries, mortgage/rent payments, vehicle cation form(s). balance. treatment. medication(s). payments, monthly bills, etc.

Verify benefits. Verify prescribed medica- Identify Identify if free Identify if manufacturer If no manufactuer Complete and If patient qualifies for Process payment If any balance, Follow up tion(s) are approved/indi- patient’s medication(s) assistance is available and assistance is avail- submit identi- manufactuer or foundation using the co-pay establish a payment with patient cated for diagnosis/place responsi- is available, complete and submit applicible able, identify if foun- fied program assistance, send an explana- card or other form plan for any left over at regular in therapy and submit bility for if necessary; form(s); may also be able to file dation assistance is application tion of benefits (EOB) and/ of payment the balance (if available) intervals pre-determination prescribed complete and for compassionate use with available. form(s). or other paperwork to verify identified program or collect remaining during or prior authorization medica- submit appli- pharmaceutical company to amount owed. offers. balance. treatment. if necessary. tion(s). cable form(s). receive medication(s).

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 15 Supporting Patients Through Their Journey on Jakafi® (ruxolitinib)

IncyteCARES (Connecting to Access, Reimbursement, Education and Support) provides a single point of contact through a registered nurse, OCN®, to assist eligible patients and healthcare providers in obtaining access to Jakafi® (ruxolitinib) and to connect them with continuing support and resources. The program offers:

REIMBURSEMENT SUPPORT • Insurance benefit verification • Information about prior authorizations • Guidance with appealing insurance denials or coverage restrictions

ACCESS ASSISTANCE • Copay/Coinsurance assistance • Free medication program • Temporary access for insurance coverage delays • Referrals to independent nonprofit organizations and foundations

EDUCATION & SUPPORT • Access to a registered nurse, OCN® • Educational information for your patients about their condition and Jakafi • Patient Welcome Kit

CONNECTION TO SUPPORT SERVICES • Referrals for transportation assistance • Access to patient advocacy organizations for counseling and emotional support resources

Connect with IncyteCARES For full program terms and eligibility, visit IncyteCARES.com or call 1-855-4-Jakafi (1-855-452-5234).

Jakafi is a registered trademark of Incyte Corporation. © 2016, Incyte Corporation. All rights reserved. RUX-1887 08/16

RUX-1887_OverviewJrnlAd_ACCC-OncologyIssues_8x10-75_x1a.indd 1 9/22/16 11:19 AM AbbVie

AbbVie, Inc.

Oncology-related products: Lupron Depot® (leuprolide acetate for depot suspension)

Patient and Reimbursement Assistance Website abbvie.com/patients/patient-assistance.html

PATIENT ASSISTANCE If patients would like to apply, they REIMBURSEMENT should work with their healthcare ASSISTANCE myAbbVie Assist provider to submit a program Patient Assistance application. Download the appli- Lupron Depot MyAbbVie Assist believes that cation (abbvie.com/content/dam/ Support Plus people who need AbbVie medicines abbvie-dotcom/uploads/PDFs/pap/ With Support Plus, providers will should be able to get them. Lupron-Application-approved.pdf), receive: MyAbbVie Assist provides free follow the instructions on the first • Patient benefit investigations medicines to qualifying patients. page, and submit all requested infor- • Precertification and prior Financial need requirements vary by mation via fax to 1.866.483.1305. authorization management medicine, and are based on patients’ • Reimbursement support insurance coverage, household Upon review of a completed appli- • Claims appeal assistance. income, and projected out-of-pocket cation, the program will notify medical expenses. Patients may the prescriber and patient about Whether it’s Medicare Advantage be eligible to receive free Lupron eligibility. If approved, it will ship or private insurance, Lupron Depot Depot if they: the medication to the prescriber’s Support Plus supports providers and • Have been prescribed Lupron office. Please call 1.800.222.6885 to their office by helping to manage Depot request refill. This program is part of the procurement process. Contact • Have limited or no health the AbbVie Patient Assistance Foun- your AbbVie Sales Representative insurance coverage dation, a separate legal entity from to learn more about how to access • Live in the United States AbbVie. Contact myAbbVie Assist at the Support Plus Program or call • Are being treated by a licensed 1.800.222.6885, Monday through 1.800.621.1020. U.S. health care provider on an Friday, for additional assistance. outpatient basis.

If patients have insurance, the program will review their qualifying financial need based on a combination of insurance coverage, household income, and out-of-pocket medical expenses. MyAbbVie Assist will evaluate patients’ insurance coverage and out-of-pocket medical expenses during the application process.

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 17 Amgen

Amgen, Inc.

Oncology-related products: Aranesp® (darbepoetin alfa) injection, Blincyto® (blinatumomab) for injection, Imlygic® (talimogene laherparepvec) suspension for injection, Kanjinti™ (trastuzumab-anns) for injection, Kyprolis® (carfilzomib) for injection, Mvasi™ (bevacizumab-awwb) injection, Neulasta® (pegfilgrastim) injection, Neulasta® Onpro® (pegfilgrastim) injection kit, Neupogen® (filgrastim) injection, Nplate® (romiplostim) injection, Prolia® (denosumab) injection, Sensipar® (cinacalcet) tablets, Vectibix® (panitumumab) for injection, Xgeva® (denosumab) injection

Patient and Reimbursement Assistance Websites amgenassist360.com amgenfirststep.com

resources, and assistance with Patient eligibility requirements: PATIENT ASSISTANCE treatment-related travel costs, • Patients must be prescribed one of Amgen Assist 360™ such as gas, tolls, parking, airfare, the medications listed above. Amgen Assist 360 is a single and lodging. • Patients must have private com- place for patients, caregivers, • If patients have questions about mercial health insurance that and healthcare professionals to their Amgen medication, Amgen covers medication costs for the go to find the support, tools, and Assist 360 can help them get the medication listed above. resources most important to them. answers they need. • Patients must not be a participant When patients enroll in Amgen in any federal, state, or govern- Assist 360, their Amgen Nurse For more information and enroll- ment-funded healthcare program, Ambassador serves as a single ment forms by medication name, such as Medicare, Medicare point of contact to help them find visit https://www.amgenassist360. Advantage, Medicare Part D, resources. Nurse Ambassadors are com/hcp/ or call 1.888.4ASSIST Medicaid, Medigap, Veterans only available to patients that are (1.888.427.7478), Monday through Affairs, the Department of prescribed certain products. Nurse Friday, 9:00 am to 8:00 pm ET. Defense, or TriCare. Ambassadors are there to support, • Patients may not seek reim- not replace, patients’ treatment Amgen FIRST STEP™ Program bursement for value received plan and do not provide medical Amgen offers this program to from the Amgen FIRST STEP advice or case management services. patients prescribed Blincyto, Imlygic, Program from any third-party Amgen 360 can: Kanjinti, Kryprolis, Mvasi, Neulasta, payers, including flexible spending • Connect patients to reimbursement Neulasta Onpro, Neupogen, Nplate, accounts or healthcare savings specialists to help with insurance Prolia, Vectibix, and Xgeva. The accounts. benefit verification and put them in program helps eligible commer- touch with programs that may help cially insured patients pay for their Other restrictions may apply. them afford their medication, such out-of-pocket prescription costs, Amgen reserves the right to revise or as Amgen FIRST STEP. including deductible, co-insurance, terminate this program, in whole or • Refer patients to independent and co-payment. in part, without notice at any time. nonprofit organizations that may provide counseling, community

18 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 19 Amgen

Amgen First Step coverage limits and • Have lived in the U.S. or its terri- REIMBURSEMENT program maximums: tories for six months or longer ASSISTANCE • Program covers out-of-pocket • Satisfy income eligibility requirements medication costs for the Amgen • Are uninsured or their insurance Amgen Assist 360™ product only. Program does not plan excludes the Amgen medicine Amgen reimbursement counselors cover any other costs related to or its generic/biosimilar. can assist with submitting, storing, office visit or administration of the and retrieving benefit verifications Amgen product. Certain Medicare Part D patients for anyone currently on an Amgen • No out-of-pocket cost for first with product coverage who cannot product. Connect with an Amgen dose or cycle; $5 out-of-pocket afford their out of pocket costs may reimbursement counselor on the cost for subsequent dose or cycle. be eligible. It is required that they phone (1.888.4ASSIST) or schedule Maximum benefit of $10,000 per are able to demonstrate: a visit from your Amgen field reim- patient per calendar year. (For • Inability to afford the medicine bursement specialist. Kanjinti, Kyprolis, and Mvasi: • Ineligibility for Medicaid or maximum benefit of $20,000 Medicare’s low-income subsidy Visit amgenassist360.com/hcp/patient- per patient per calendar year; for (Extra Help) support/amgen-access-specialist Prolia: $25 out-of-pocket cost for • Have satisfied all payer guidelines for more information. subsequent dose or cycle, maximum and Prior Authorization (PA) benefit of $1,500 per patient per requirements prior to applying Visit the benefit verification center calendar year.) Patient is responsible for assistance for tools, information, and support. for costs above these amounts. • Do not have any other financial To begin, choose the applicable support options. Amgen product at www.amgen To confirm patient eligibility and assistonline.com. enroll in one of these programs, visit To apply, visit amgensafetynet amgenfirststep.com/register-card or foundation.com/how-to-apply.html, For more information, call call 1.888.65.STEP1 (1.888.657. select the appropriate medication, fill 1.888.4ASSIST (1.888.427.7478), 8371), Monday through Friday, 9:00 out and sign the Patient Application, Monday through Friday, 9:00 am to am to 8:00 pm ET. and fax the completed application 8:00 pm ET. to 1.866.e549.7239. Independent Nonprofit Programs Once a completed application and For patients with government any requested supporting documents insurance (like Medicare), Amgen have been received and processed, Assist 360 can refer them to inde- the patient and provider will be pendent nonprofit patient assistance notified of the enrollment decision. programs that may be able to help Eligible patients are enrolled for a them afford the co-pay costs for period up to 12 months. To re-enroll their prescribed medicine. Program in Amgen Safety Net Foundation, eligibility is based on the nonprofit’s patients must submit a new criteria. Amgen has no control application. over these programs and provides referrals as a courtesy only. For questions, call 1.888.762.6436, Monday through Friday, 8:00 am to Amgen Safety Net 8:00 pm ET. Foundation Patients may be able to receive Amgen medications at no cost from Amgen Safety Net Foundation (amgensafetynetfoundation.com) if they meet the following eligibility requirements:

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 19 Astellas

Astellas Pharma U.S., Inc.

Oncology-related products: Padcev™ (enfortumab vedotin-ejfv) injection for intravenous use (jointly owned by Seattle Genetics), Xospata® (gilteritinib) tablets, Xtandi® (enzalutamide) capsules

Patient and Reimbursement Assistance Website astellaspharmasupportsolutions.com

PATIENT ASSISTANCE complete the Xtandi or Xospata • Have been prescribed Xospata for Support Solutions enrollment an FDA-approved indication Astellas Pharma Support process, including the PAP appli- • Have experienced an insurance- SolutionsSM cation submitted through the portal related access delay. Astellas Pharma Support Solutions or faxed to the number on the form. offers access and reimbursement If the patient is eligible, the patient To enroll, fill out the appropriate support to help patients overcome and provider will be notified, and section during the Xospata Support challenges to accessing Astellas the prescription will be shipped Solutions patient enrollment process. products. To enroll in Padcev, directly to the patient’s home. Xospata, or Xtandi Support Xospata Copay Card Program Solutions, visit astellaspharma- Xospata Support SolutionsSM The Xospata Copay Card Program supportsolutions.com, select the Xospata Support Solutions (astellas is for eligible patients who have appropriate medication, and follow pharmasupportsolutions.com/ commercial prescription insurance. the patient enrollment process. products/xospata/index.aspx) offers The Program parameters are as access and reimbursement support follows: Astellas Patient Assistance to help patients access Xospata. • Patients pay as little as $0 per Program It provides information regarding prescription The Astellas Patient Assistance patient healthcare coverage options • A patient will be enrolled in the Program provides Xtandi or and financial assistance infor- program for a 12-month period Xospata at no cost to patients who mation that may be available to • The program benefit covers up meet the program eligibility require- help patients with financial needs. to a maximum of $25,000 per ments. The patient may be eligible To speak with a dedicated access calendar year if they meet the following criteria: specialist, call 1.844.632.9272, • There are no income requirements. • Patient is uninsured or has Monday through Friday, 8:30 am insurance that excludes coverage to 8:00 pm ET. Xospata Support Solutions can for Xtandi or Xospata. evaluate eligibility and enroll • Patient has a verifiable shipping Xospata Quick Start+® Program patients in the Xospata co-pay card address in the United States. The Xospata Quick Start+ Program program, or the preferred network • Patient has been prescribed Xtandi provides a one-time, 7-day supply of specialty pharmacy can be contacted or Xospata for an FDA-approved Xospata at no cost to eligible patients to determine eligibility and enroll the indication. who experience an insurance-related patient in the program. • Patient meets program financial delay. Overnight shipping is offered eligibility requirements. directly to the patient. To be eligible, The program is not valid for patients patients must: whose prescription claims are To enroll a patient in the Astellas • Have prescription drug insurance reimbursed, in whole or in part, Patient Assistance Program, • Be new to Xospata therapy by any state or federal government

20 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 21 Astellas

program, including, but not limited • Patients can pay as little as $0 per PADCEV Copay Assistance to Medicaid, Medicare, Medigap, prescription Program Department of Defense (DoD), • Patients will be enrolled in the The PADCEV Copay Assistance Veterans Affairs (VA), TriCare, program for a 12-month period Program is for eligible patients who Puerto Rico government insurance, • The program benefit covers up have private commercial health or any state patient or pharmaceu- to a maximum of $25,000 per insurance and are not insured by any tical assistance program. This offer calendar year federal or state healthcare program, is not valid for cash-paying patients. • There are no income requirements. including, but not limited to, Medicare, Medicaid, TriCare, or Veterans Xtandi Support SolutionsSM Patients must provide their Savings Affairs (VA). Under this Program: Xtandi Support Solutions (astellas Card ID number to the specialty • Patients pay as little as $5 per dose pharmasupportsolutions.com/ pharmacy when they fill their pre- • A patient will be enrolled in the products/xtandi/index.aspx) offers scription. Patients can receive their Program for a 12-month period access and reimbursement support to savings card by contacting their • Patients may save up to a help patients overcome challenges to specialty pharmacy or by applying maximum of $25,000 per accessing Xtandi. It provides infor- at activatethecard.com/xtandi. calendar year mation regarding patient healthcare • There are no income requirements. coverage options and financial assis- The program is not valid for patients tance options that may be available whose prescription claims are This offer is not valid for patients to help patients with financial needs. reimbursed, in whole or in part, insured by any federal or state To speak with a dedicated access spe- by any state or federal government healthcare program, including, but cialist, please call 1.855.8XTANDI program, including, but not limited not limited to, Medicaid, Medicare, (1.855.898.2634), Monday through to, Medicaid, Medicare, Medigap, Medigap, Department of Defense, Friday, 8:00 am to 8:00 pm ET. Department of Defense, Veterans Veterans Affairs, TriCare, Puerto Affairs, TriCare, Puerto Rico Rico government insurance, or Xtandi Quick Start+® Program government insurance, or any state any state patients or pharmaceu- The Xtandi Quick Start+ Program patient or pharmaceutical assistance tical assistance program. This provides a one-time, 14-day supply program. Contact Xtandi Support offer is not valid for cash-paying of Xtandi at no cost to new patients Solutions at 1.855.898.2634 or the patients. Padcev Support Solutions who experience a delay in insurance Xtandi specialty pharmacy for help can evaluate eligibility and enroll coverage. Overnight shipping is enrolling patients into this program. patients in the Padcev Copay offered directly to the patient. Assistance Program. For more Patient eligibility for the for the PADCEV Support SolutionsSM information, contact Padcev Support program, includes: PADCEV Support Solutions Solutions at 1.888.402.0627, • Have prescription drug insurance (astellaspharmasupportsolutions.com/ Monday through Friday, 8:30 am • Be new to Xtandi therapy products/padcev/index.aspx), offers to 8:00 pm ET. • Have experienced an insurance- access and reimbursement support related access delay to help patients access Padcev. It PADCEV Patient Assistance • Have been prescribed Xtandi provides information regarding Program for an FDA-approved indication. patient healthcare coverage, financial The PADCEV Patient Assistance assistance information that may Program provides Padcev at not cost To enroll, fill out the appropriate be available to help patients with to uninsured patients who meet the section during the Xtandi Support financial needs, and coding and program eligibility requirements. Solutions patient enrollment process. billing information for Padcev. Padcev Support Solutions will evaluate a patient’s eligibility for the program. Xtandi Patient Savings Program To speak with a dedicated access spe- Patients may be eligible if they: The Xtandi Patient Savings Program cialist, please call 1.888.402.0627, • Do not have insurance or have is for eligible patients who have Monday through Friday, 8:30 am to insurance that excludes coverage commercial prescription insurance. 8:00 pm ET. for Padcev The program parameters are as • Have a verifiable shipping address follows: in the United States

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 21 Astellas

• Have been prescribed Padcev for Astellas Pharma Support Solutions an FDA-approved indication will initiate the benefits verification • Meet the program financial eligi- upon receipt of the specific medi- bility requirements. cation’s Patient Enrollment Form. Once it is complete, a summary of To enroll, complete the Patient benefits will be sent. Enrollment Form (astellaspharma- supportsolutions.com/docs/PADCEV/ Prior Authorization PADCEVSupportSolutions_Patient_ Astellas Pharma Support Solutions Enrollment_Form.pdf), including can provide prior authorization (PA) all signatures, and either upload assistance when a patient’s insurer it through the prescriber portal requires PA approval. After deter- (padcev.aspnprograms.com/) or fax mining that a PA is required, the it to 1.877.747.6843. If the patient program will obtain the appropriate is eligible for the program, Padcev PA form and transfer basic patient Support Solutions will notify the and healthcare provider information provider and the patient. to the required PA form. It will then be sent to the healthcare provider For more information, contact to review, complete, and sign. 1.888.402.0627, Monday through Astellas Pharma Support Solutions Friday, 8:30 am to 8:00 pm ET. will follow up with the insurer to confirm receipt, check status, and REIMBURSEMENT obtain the outcome. ASSISTANCE If the patient’s insurer denies a Astellas Pharma Support prior authorization request, Astellas SolutionsSM Pharma Support Solutions can assist Benefits Verification the healthcare provider with an Astellas Pharma Support Solutions appeal for a denied prior authori- offers benefits verification assistance zation request. Xtandi, Xospata, to evaluate a patient’s insurance or Padcev Support Solutions coverage for Xtandi, Xospata, or will determine if any additional Padcev. After performing a benefits documentation is required by verification, a summary of benefits the patient’s insurer, inform the will be provided that includes: healthcare provider of what infor- • The patient’s insurance coverage mation is needed and where to send for the specific medication the appeal, and track and inform the • Requirements for prior authori- healthcare provider of the appeal’s zation, step edit, or other coverage status. restrictions, if any • Cost-sharing responsibility, including the deductible, coin- surance or copayment, and out-of-pocket maximums • A list of specialty pharmacies that participate in the patient’s insurance plan for the specific medication, if applicable.

22 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 23 AstraZeneca

AstraZeneca

Oncology-related products: Calquence® (acalabrutinib) capsules, Faslodex® (fulvestrant) injection, Imfinzi® (durvalumab) injection for intravenous use, Iressa® (gefitinib) tablets, Lynparza® (olaparib) tablets, Tagrisso® (osimertinib) tablets

Patient and Reimbursement Assistance Websites astrazenecaspecialtysavings.com MyAccess360.com

PATIENT ASSISTANCE the online enrollment portal. To learn more about the Astra- The links to the portal for each Zeneca Access 360 program, call AstraZeneca Patient product can be found at 1.844.ASK.A360 (1.844.275.2360), Savings Programs astrazenecaspecialtysavings.com. Monday through Friday, 8:00 am The goal of the AstraZeneca Patient 3. A Patient Savings Program to 8:00 pm ET or visit www. Savings Programs is to assist eligible account will be created for the MyAccess360.com. patients with their out-of-pocket eligible patient. Once enrolled, costs. Most eligible patients will pay patient-specific account infor- The AZ&Me™ Prescriptions $0 per supply or infusion, dependant mation will be presented in the Savings Program on the specific medication, and portal for immediate use. The AZ&Me Prescriptions Savings subject to annual maximums. There 4. The patient will pay a set amount Program is designed to help qualified are no income requirements to par- of their out-of-pocket costs, based patients without insurance and those in ticipate in these programs. on the product. The pharmacy or Medicare who are still having trouble provider will use the Patient Savings affording their AstraZeneca medica- Patients are ineligible if prescrip- Program to cover the balance, up to tions. There are two programs: tions are paid by any state or the program maximum. • AZ&Me Prescription Savings other federally funded programs, program for people without including, but not limited to, For more information about eligi- insurance. Medicare Part B, Medicare Part bility and details on these programs, • AZ&Me Prescription Savings D, Medicaid, Medigap, Veterans please visit astrazenecaspecialty program for people with Affairs (VA), or TriCare, or where savings.com or call AstraZeneca Medicare. prohibited by law. Eligibility rules Access 360 at 1.844.ASK.A360 apply. Offer is invalid for claims and (1.844.275.2360), Monday through There is a shared application transactions more than 120 days Friday, 8:00 am to 8:00 pm ET. process for the AZ&Me Prescription from the date of service. Savings Program for people without AstraZeneca Access 360™ insurance and the AZ&Me Pre- How the Programs Work: The AstraZeneca Access 360 scription Savings Program for people 1. Patients may have an program provides personal support with Medicare, and the same appli- out-of-pocket cost for an to help streamline access and reim- cation is used for both programs. AstraZeneca specialty product. bursement for select AstraZeneca To apply for the program patients 2. If the patient meets the eligibility medicines. Access 360 provides: and providers may either call 1.800. requirements, healthcare profes- • Pharmacy coordination AZandMe (1.800.292.6363) or visit sionals can enroll patients into • Reimbursement support azandmeapp.com to download, fill the Patient Savings Program via • Patient affordability. out, and fax the completed appli-

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 23 AstraZeneca

cation from the provider’s office to Please note that faxed applications 1.877.239.0867. For an updated list must be sent from a provider's office of the medications available through in order for the prescription the AZ&Me Prescription Savings to be processed. Program, please visit the eligibility page (www.azandmeapp.com/ For more information, please visit eligibility.html#hcp). azandmeapp.com or call 1.800. AZandME (1.800.292.6363). Eligibility Requirements: • Patient must be a resident of the REIMBURSEMENT United States. ASSISTANCE • Patient must not be currently receiving prescription drug AstraZeneca Access 360™ coverage under a private Access 360 can assist providers and insurance or government program patients with: (excluding Medicare), or receiving • Benefit investigation any other assistance to help pay • Prior authorization support for medicine. • Claims and appeal process • Patient's annual income must be support. at or below a certain level. For more information, call 1.844. If the patient is a Medicare Benefi- ASK.A360 (1.844.275.2360), ciary, they must not be eligible for Monday through Friday, 8:00 am or enrolled in Low Income Subsidy to 8:00 pm ET or visit (LIS) for Medicare Part D, and myaccess360.com. they must have spent at least three percent of their annual household income on prescription medicines in the current year.

Application Checklist The following items must be submitted in order to complete the patient application: • A completed application, signed and dated by the patient and prescriber • A completed prescription on page three of the application • If the patient is a Medicare enrollee, please also include a copy of their Medicare Part B and/or Medicare Part D Prescription Drug statement, or a summary document from the pharmacy indicating the amount spent on prescriptions in the current calendar year.

24 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 25 Bayer HealthCare

Bayer HealthCare Pharmaceuticals, Inc.

Oncology-related products: AliqopaTM (copanlisib) for injection, Nexavar® (sorafenib) tablets, Nubeqa® (darolutamide) tablets, Stivarga® (regorafenib) tablets, Vitrakvi® (larotrectinib), Xofigo® (radium Ra 223 dichloride) injection

Patient and Reimbursement Assistance Websites nubeqa-us.com hcp.xofigo-us.com/patient-financial-assistance zerocopaysupport.com hcp.aliqopa-us.com/access-and-reimbursement/arc-program/ hcp.vitrakvi-us.com/access/ hcp.nexavar-us.com/Resources/REACH-Financial-Support/

PATIENT ASSISTANCE com/coordinate-patient-care/ payors, such as the Department of getting-patients-started/patient- Veterans Affairs and Department of Xofigo Access Services financial-assistance) and fax Defense), patients are not eligible. Xofigo Access Services is your one the application, including the Eligibility criteria include: course for treatment support and signed patient authorization, • Patient has private commercial ordering Xofigo. to 1.855.963.4463. Registered insurance. providers can also submit an • Patient resides in the United Xofigo Patient Assistance application for patient assistance States, including the District of Program via the secure Xofigo Access Columbia, Puerto Rico, Guam, or Xofigo Access Services may provide Services Provider Portal at the U.S. Virgin Islands. Xofigo free of charge for eligible xofigoaccessonline.com/. patients who are uninsured or who To apply, fax a completed Xofigo are insured but do not have coverage For more information, call 1.855. Access Services Commercial Copay for Xofigo. Eligibility criteria 6XOFIGO (1.855.696-3446), Assistance Application (hcp.xofigo-us. include: Monday through Friday, 9:00 am com/coordinate-patient-care/getting- • Financial criteria based on to 7:00 pm ET. patients-started/copay-assistance/), adjusted gross household income including the signed patient autho- (documentation of income is $0 Commercial Copay rization and an assignment of required) Assistance Program commercial copay/coinsurance • Residency in the United States, Patients may be eligible for assistance, to Xofigo Access Services including the District of copayment/coinsurance assistance at 1.855.963.4463. Once approved, Columbia, Puerto Rico, Guam, or if they have a private commercial patients will receive an approval the U.S. Virgin Islands. plan that covers Xofigo. Patients letter with a commercial copay/coin- approved for assistance will not have surance identification (ID) card. To enroll, complete the Xofigo to pay anything to access Xofigo. Access Services Patient Assis- If patients have public insurance tance Application (hcp.xofigo-us. (e.g., Medicare or other government

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 25 Bayer HealthCare

Independent Copay/Coinsurance program allows patients to fill their • Not have insurance, or have Assistance Foundations prescription with no out-of-pocket coverage for their Bayer pre- If patients have Medicare or other costs. Patients can receive up-to scription medication. government insurance and need $25,000 in saving with no monthly assistance with their cost-share maximum. To be eligible patients must: To apply, complete the enrollment requirements for Xofigo, they may • Be a United States resident form (www.patientassistance.bayer. be eligible for copay or coinsurance • Be over 18-years-old us/en/resources/), and fax it to assistance through an independent • Currently have commercial health 1.866.575.6568. foundation. Xofigo Access Services insurance for a portion of their access counselors can verify patients’ prescription drug cost Aliqopa Resource coverage for Xofigo and provide • Not be enrolled in any federal Connections information about any available or state subsidized healthcare The ARC patient support program foundation. The foundations will program that covers a portion offers comprehensive access, reim- determine patients’ eligibility for of their prescription drug costs, bursement support, and patient copay or coinsurance assistance including Medicare (such as assistance services, including: based on their own criteria. Medicare Part D prescription • The Bayer U.S. Patient Assis- drug benefit), Medicaid, TriCare, tance Foundation for qualified REACH® or any other federal or state uninsured or underinsured Patients taking Stivarga or Nexavar healthcare plan, including phar- patients. Bayer U.S. Patient Assis- can enroll in REACH (Resources maceutical assistance programs. tance Foundation is a charitable for Expert Assistance and Care organization that helps eligible Helpline). REACH provides Enroll online at zerocopaysupport.com patients get Bayer prescription patients with information about by clicking on the specific medica- medicine at no cost. their therapy, helps them evaluate tion. For questions about the co-pay • The Temporary Patient Assis- their financial assistance options, program, call 1.866.581.4992 from tance Program for patients whose and offers education and support 9:00 am to 5:00 pm ET. coverage is delayed or who to health care professionals. The experience a temporary lapse in REACH program offers nurse coun- Independent Charitable coverage for Aliqopa. selors to answer questions, educate Organizations • The Aliqopa $0 Co-Pay Program on adverse event management, REACH provides referrals to inde- for eligible patients with com- and provide education materials. pendent organizations that may mercial insurance. Patients must REACH service counselors can assist eligible patients with their out- not be enrolled in a govern- provide help with: of-pocket expenses. Patients who ment-sponsored program and • Reimbursement assistance do or do not meet the requirements must meet certain other eligibility • Alternate coverage research for for REACH do not automatically criteria to qualify for this program. the uninsured or underinsured qualify for financial help from chari- If approved, the patient may pay • $0 Co-Pay Assistance for privately table organizations. as little as $0, with a maximum insured patients benefit of $25,000 per year. • Referral of qualified patients Bayer U.S. Patient Assistance • Referrals to independent assis- to charitable organizations for Foundation tance foundations for publicly assistance with their out-of-pocket Bayer U.S. Patient Assistance Foun- insured patients and those expenses. dation (www.patientassistance.bayer. requiring travel assistance. us/) is a charitable organization For more information, call that helps eligible patients get Bayer To enroll in the ARC Program, fax 1.866.639.2827 or visit the prescription medicine at no cost. To the completed enrollment form prescribed medication's website. be eligible for the Bayer U.S. Patient (hcp.aliqopa-us.com/access-and- Assistance Foundation free drug reimbursement/arc-program/) Oncology $0 Co-Pay Program program, patients must: to 833.427.2329. For more For eligible, commercially insured • Live in the United States or Puerto information, call 833.ALIQOPA patients prescribed Nexavar or Rico (833.254.7672), Monday through Stivarga, the zero dollar co-pay • Meet certain income limits Friday, 9:00 am to 7:00 pm ET.

26 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 27 Bayer HealthCare

DUDE Access Services™ indication, being treated in the (1.888.506.8725). For more infor- DUDE (Darolutamide User Drug U.S., including, Puerto Rico, Guam, mation, call 1.844.634.TRAK Experience) Access Services provides and U.S. territories. For questions (1.844.634.8725). Monday through a range of services and resources about the Nubeqa $0 co-pay Friday, 9:00 am to 7:00 pm ET. to help patients access therapy, program, call 1.833.337.DUDE including: (1.833.337.3833). Vitrakvi Commitment Program™ • Two-month free trial Bayer will provide full or partial • $0 co-pay program TRAK Assist™ refunds (for up to 60 days) to • Referrals to charitable founda- TRAK Assist provides several patients (through the Bayer tions, including the Bayer U.S. options to help patients access their In-Network Specialty Pharmacy) for Patient Assistance Foundation Vitrakvi treatment, including: patients who do not receive clinical • Reimbursement and access • TRAK Assist $0 Co-Pay Program benefit within 90 days of initiation support. for eligible patients with commercial on Vitrakvi. Program rules apply. or private insurance. Patients who For more information, visit www. To provide these savings to your are enrolled in any type of gov- hcp.vitrakvi-us.com/access/ or call patients and benefit from the advan- ernment insurance or reimbursement 1.844.634.TRAK (1.844.634.8725). tages of DUDE Access Services, programs are not eligible. complete and fax the Patient Service • Vitrakvi Bridge Program for REIMBURSEMENT Request form (nubeqahcp.com/ commercially insured patients ASSISTANCE sites/g/files/vrxlpx1306/files/2020-03/ whose coverage is delayed or who Nubeqa_PatientServiceRequestForm. experience a temporary lapse in Xofigo Access Services pdf) to 1.844.NUBEQA3 (1.844. coverage. This program provides Xofigo Access Services assists 682.3723). Or call 833.337.DUDE free Vitrakvi for a limited period healthcare professionals with: (1.833.337.3833), Monday through of time while a patient is without • Insurance benefits verifications Friday, 9:00 am to 7:00 pm ET. coverage. • Prior authorization support • Referrals to independent assis- • Claims appeal research and Nubeqa Free Trial Program tance foundations for publicly information The Nubeqa free trial program insured patients who need help • Claims tracking provides two months’ supply of with out-of-pocket costs related • Billing and coding guidance Nubeqa at no cost to patients to their treatment. TRAK Assist • Payer policy information. who meet the program eligibility offers referrals to third-party requirements and agree to the terms assistance programs; eligibility To access these services, call and conditions. To be eligible, criteria apply. 1.855.6XOFIGO (1.855.696.3446) patients must reside in the United • Bayer U.S. Patient Assistance 9:00 am to 7:00 pm ET, Monday States or Puerto Rico and be a Foundation for qualified through Friday. You can also access new patient not currently using uninsured or underinsured these services online 24/7 through the Nubeqa or who previously received patients. Xofigo Access Services Provider Portal Nubeqa through the free trial (www.xofigoaccessonline.com/). program. For more information TRAK Assist also provides a please call, 1.833.337.DUDE dedicated phone line that provides REACH® (1.833.337.3833). patients direct access to a nurse The REACH program offers: or pharmacist who can answer • Benefit verification Nubeqa $0 Co-Pay Program questions about treatment with • Specialty pharmacy provider Commercially insured patients Vitraki. To enroll patients in identification may qualify for $0 co-pay. The TRAK Assist, download the TRAK • Prior authorization Nubeqa $0 co-pay program Assist Enrollment Form (www. • Denial/appeal information. benefit has a maximum amount hcp.vitrakvi-us.com/resources/), of $25,000 per year, per patient. and fax the completed form, Visit https://www.nexavar-us.com/ The Nubeqa co-pay program is along with copies of the patient’s co-pay-assistance/ or https://www. for commercially insured patients pharmacy insurance card(s) (front stivarga-us.com/getting-and-paying/ using Nubeqa for an approved FDA and back), to 1.888.506.TRAK REACH/ for more information.

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 27 Bayer HealthCare

Aliqopa Resource Connections The ARC patient support program offers comprehensive access, reim- bursement support, and patient assistance services, including: • Insurance benefit verifications • Prior authorization information (physician office must submit prior authorization) • Claims appeal information • Claims status • Billing and coding information • Payer policy information.

For more information, call 833. ALIQOPA (833.254.7672), Monday through Friday, 9:00 am to 7:00 pm ET or visit hcp.aliqopa-us. com/access-and-reimbursement/ arc-program/.

DUDE Access Services™ Reimbursement, access, and other types of support are available. DUDE Access Services will connect you to representatives who can help with benefits verification, prior authorization assistance, and appeal support. For more information, call 833.337.DUDE (1.833.337.3833), Monday through Friday, 9:00 am to 7:00 pm ET.

TRAK Assist™ TRAK Assist provides access support and coverage assistance. Patient coverage support, includes: • Insurance benefit investigation • Prior authorization and appeals support • Sample documentation • Payer policy information.

For more information, call 1.844.634.TRAK (1.844.634.8725), Monday through Friday, 9:00 am to 7:00 pm ET.

28 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 29 BeiGene

BeiGene

Oncology-related products: Brukinsa™ (zanubrutinib) capsules

Patient and Reimbursement Assistance Website brukinsa.com/patient-support

PATIENT ASSISTANCE Oncology nurse advocates are REIMBURSEMENT available Monday through Friday ASSISTANCE myBeiGene™ from 8:00 am to 8:00 pm ET at The myBeiGene program is a com- 1.833.BeiGene (1.833.234.4363) to myBeiGene™ prehensive patient support program provide information and answer any The myBeiGene program is a com- designed to provide appropriate questions regarding the myBeiGene prehensive patient support program information and assistance to patient support program. designed to provide appropriate patients. Dedicated oncology nurse information and assistance to advocates provide personalized Co-Pay/Co-Insurance Assistance patients, including assistance with: support for patients and their Eligible commercially insured • Insurance verification caregivers based on each patient's patients may have a co-pay as little • Prior authorization support. individual needs. MyBeiGene as $0 per prescription. There is no program services, include: patient income requirement. The For more information, call • Assisting with insurance verifi- program is subject to an annual 1.833.BeiGene (1.833.234.4363), cation and prior authorization benefit limit of $25,000. Patients are Monday through Friday, 8:00 am support ineligible if prescriptions are payable to 8:00 pm ET. • Co-pay as little as $0/prescription by any state or federally funded for commercial patients programs, including, but not limited • Bridge supply for insurance to, Medicare, Medicaid, Veterans coverage delays Affairs (VA), or TriCare, or where • Free product for uninsured and prohibited by law. Eligibility criteria underinsured patients (Certain and restrictions apply. financial and eligibility criteria apply) Bridge Supply • Education and support Eligible patients may receive a • Connections to third-party 15-day supply of medication (for advocacy organizations. on-label use only) in cases of a coverage delay lasting longer than 5 Complete the online form (www. days. Eligibility criteria and restric- brukinsa.com/hcp/mybeigene-patient- tions apply. enrollment) to enroll in myBeiGene or fax the completed Patient For more information and Enrollment Form (brukinsa. questions, call 1.833.BeiGene com/enrollment-form.pdf) to (1.833.234.4363), Monday through 1.877.828.5593. Friday, 8:00 am to 8:00 pm ET.

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 29 Blueprint Medicines

Blueprint Medicines

Oncology-related products: Ayvakit™ (avapritinib) tablets, Gavreto™ (pralsetinib) capsules

Patient and Reimbursement Assistance Website yourblueprint.com/hcp/

PATIENT ASSISTANCE reduce their out-of-pocket costs eligible to receive their medication (co-pay, co-insurance, or deductible) at no cost through this program. YourBlueprint™ to as little as $0. Patients must have To qualify for this program, patients YourBlueprint facilitates access and commercial insurance with coverage must meet certain requirements, reimbursement, including: for their prescription. Uninsured or including: • Comprehensive benefits verification cash paying patients are not eligible. • Have a valid prescription for a • Assistance with prior authorization, Electronic enrollment is required. Blueprint Medicine therapy appeals, and exceptions Offer is not available to patients • Reside in the United States or U.S. • Connecting patients with financial whose prescription claims are eligible territory assistance options to be reimbursed, in whole or in part, • Meet financial eligibility criteria. • Access to temporary treatment by any governmental program, such programs for patients who have a as patients enrolled in Medicare Part To be evaluated for assistance, delay or lapse in insurance coverage. D and patients whose prescription complete and submit the medi- is paid for by Medicare, Medicaid, cation-specific enrollment form To enroll, complete the medi- Medigap, CHAMPUS, Department (https://yourblueprint.com/hcp/) via cation-specific Patient Support of Defense (DoD), TriCare, Veterans fax to 1.866.370.3082 or email to Program Enrollment Form (https:// Affairs (VA), Children’s Health [email protected]. yourblueprint.com/hcp/) and submit Insurance Program (CHIP), the it online, or fax the completed form Indian Health Service, or a state Independent Charitable to 1.866.370.3082, or email it to pharmaceutical assistance program. Foundations [email protected]. Once Blueprint Medicines reserves the right Case managers can provide you with the completed enrollment form to rescind, revoke, or amend the contact information for independent is submitted, the patient’s case program and discontinue support charitable foundations that might be manager will contact the healthcare at any time without notice. able to assist patients. These founda- professional by phone to confirm tions are not associated with Blueprint enrollment and discuss next steps To begin the process of determining Medicines and establish their own based on the services requested. patient eligibility and enrollment in rules and application processes. the Co-Pay Assistance Program, visit Blueprint Medicines does not endorse To speak with a dedicated case portal.trialcard.com/yourblueprint/. any particular foundation. manager, call 1.888.BLUPRNT For any questions, contact customer (1.888.258.7768), Monday through support at 1.888.BLUPRNT Uninterrupted Access Friday, 8:00 am to 8:00 pm ET. (1.888.258.7768). YourBlueprint offers the following no cost options to eligible patients Co-Pay Assistance Program Patient Assistance Program who need assistance accessing This program helps eligible, If a patient is uninsured or has their Blueprint Medicines therapy commercially insured patients limited coverage, they may be while awaiting an insurance

30 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 31 Blueprint Medicines

coverage determination or while REIMBURSEMENT For more information, visit transitioning between doses. These ASSISTANCE yourblueprint.com/hcp or call programs include: 1.888.BLUPRNT (1.888.258.7768), • QuickStart Program: This YourBlueprint™ Monday through Friday, 8:00 am program offers a no cost 15-day Benefits Verifications to 8:00 pm ET. supply of therapy to newly Case managers can conduct a prescribed patients who have an benefits verification to determine insurance coverage delay. Eligible patients; health insurance coverage patients may receive three refills and out-of-pocket costs. After pending insurance coverage. The verifying coverage, the program will program is available to patients provide a summary of benefits to with private/commercial or gov- the provider’s office over the phone, ernment insurance experiencing as well as fax. For the patient, it delays in coverage. Patients must can call to review the summary of be new to therapy and enrollment benefits verbally, and upon request, in YourBlueprint is required. mail a copy to the patient. • Coverage Interruption Program: This program provides a no Prior Authorization cost 15-day supply of treatment Case managers can support patients to eligible patients already on through the process of managing therapy who face a temporary a prior authorization requirement. interruption in insurance Here is what to expect: coverage. Eligible patients may • First, YourBlueprint will coor- receive three refills pending dinate with patients’ insurer to insurance coverage. Patients must gather the prior authorization be on therapy and enrollment in requirements, including the payer YourBlueprint is required. specific documents. • Ayvakit Dose Exhange Program: • A case manager will then contact This program allows patients the provider’s office to help guide who have a change in their dose them through the submission of Ayvakit to exchange remaining process and provide the necessary medication for the new dose. To documents, including a documen- apply to this program, please tation checklist. complete the Ayvakit dose • After the provider’s office submits exchange form (https://yourblue- the prior authorization request, print.com/wp-content/uploads/ upon request, YourBlueprint can AYVAKIT-Dose-Exchange-Form. track the progress and com- pdf) and submit it to YourBlue- municate the status of a prior Print via fax to 1.866.370.3082 or authorization to you. email to [email protected]. Appeals To speak with a dedicated case In the event of a prior authorization manager, call 1.888.BLUPRNT denial, case managers can assist with (1.888.258.7768), Monday through an appeal of the payer’s decision via Friday, 8:00 am to 8:00 pm ET. a request for reconsideration by providing: • Additional guidance on types of information to include • A documentation checklist • A sample letter of medical necessity and/or a sample letter of appeal.

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 31 Bristol Myers Squibb

Bristol Myers Squibb

Oncology-related products: Empliciti® (elotuzumab) for injection, Onureg® (azacitidine) tablets, Opdivo® (nivolumab) injection for intravenous use, Sprycel® (dasatinib) tablets, Yervoy® (ipilimumab) injection for intravenous use

Patient and Reimbursement Assistance Website bmsaccesssupport.com

PATIENT ASSISTANCE commercial (private) insurance and and fax the completed form to live in the United States or Puerto 1.888.776.2370. BMS Access Support® Rico. Enrolled patients pay the first • Begin the enrollment process online Bristol Myers Squibb (BMS) is $25 of the co-pay for each dose of with the secure portal: https://www. committed to helping appropriate a BMS medication covered by the mybmscases.com/app/login#/. patients get access to BMS med- program. Bristol Myers Squibb will • Call BMS Access Support at ications by providing access and cover the remaining amount up to a 1.800.861.0048. Monday through reimbursement support services. maximum of $25,000 per year, per Friday, 8:00 am to 8:00 pm ET. The BMS Access Support program patient, per product. If a patient is offers benefits reviews, prior authori- prescribed two BMS medications BMS Access Support will notify the zation assistance, and appeal process in combination, the maximum is provider and patient of the result support, as well as an easy-to-initiate $50,000. For patients prescribed and the appropriate next steps. For co-pay assistance process and infor- Onureg, eligible patients with an questions or to confirm receipt of the mation on financial support. activated co-pay card and a valid application, call the Support Center prescription may pay as little as at 1.800.861.0048, Monday through BMS Oncology $10 per 30-day supply, subject to Friday, 8:00 am to 8:00 pm ET. Co-Pay Assistance Program a maximum benefit of $15,000 per The program provides financial calendar year (excluding certain Assistance for assistance with out-of-pocket dispensing costs) and a maximum Uninsured Patients deductibles, co-pay, or co-insurance of $6,850 per prescription. The For patients without prescription costs for eligible patients who have Program may apply retroactively to drug insurance, or for patients been prescribed certain BMS out-of-pocket expenses that occurred who are underinsured, BMS Access oncology products. Patients are not within 120 days prior to the date Support can make a referral to eligible if they have prescription of the enrollment. The enrollment independent charitable foundations insurance coverage through a state period is one calendar year. that may be able to help, including or federal healthcare program, the Bristol Myers Squibb Patient including but not limited to Obtain the Enrollment Form in one Assistance Foundation (BMSPAF): Medicare, Medicaid, MediGap, of the following ways: bmspaf.org. The BMSPAF is a char- CHAMPUS, TriCare, Veterans • Download the Oncology Access itable organization that may also Affairs (VA), or Department of and Reimbursement Support provide medicine, free of charge, to Defense (DoD) programs; patients form (https://www.bmsaccess- eligible, uninsured patients who have who move from commercial to support.bmscustomerconnect. an established financial hardship. state or federal healthcare program com/servlet/servlet.FileDown- insurance will no longer be eligible. load?file=00Pi000000nzWysEAE) To be eligible, patients must have

32 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 33 Bristol Myers Squibb

Patients may be eligible for assis- • One-month free trial offer for Reviews are typically completed tance through the BMSPAF if they: new, eligible Medicare, Medicaid, within a median time of 24 hours. • Do not have insurance coverage and cash-paying patients For enrolled patients, benefits may for prescribed medicated listed • Benefits review to assist in also be reverified. on its site verifying coverage • Live in the United States, Puerto • Information, support, and Prior Authorization Rico, or U.S. Virgin Islands resources every step of the way. BMS Access Support can assist by • Are being treated by a U.S.-licensed providing information about the prescriber Co-Pay Assistance prior authorization process. A BMS • Are being treated as an outpatient For eligible commercially Access Support care coordinator • Have a yearly income that is at or insured patients, patients pay $0 can conduct benefits review, obtain below 300 percent of the Federal out-of-pocket drug cost per information about any prior autho- Poverty Level. Medications that one-month supply and the program rization requirement, call the payer are injected and certain prescribed covers a maximum of $15,000 in to obtain prior authorization details, medications for cancer may be co-pays per calendar year (excluding and fax summary of benefits to the subject to higher limits. certain dispensing costs). Patients provider must have commercial (private) Other eligibility criteria may insurance, but their coverage does Claims Appeals apply. For more information not cover the full cost of the pre- If the patient’s insurer has denied about eligibility, call BMSPAF at scription. Patients are not eligible coverage, BMS Access Support may 1.800.736.0003. if they have prescription insurance be able to assist by providing infor- coverage through a state or federal mation about the appeals process. It Assistance for Patients healthcare program, including is important to review the insurer’s with Federally-Funded but not limited to Medicare, guidelines and to submit the Insurance Plans Medicaid, MediGap, CHAMPUS, required documents and information Patients insured through Federal TriCare, Veterans Affairs (VA), before the appeal deadline. Healthcare Programs are not eligible or Department of Defense (DoD) for co-pay assistance programs programs; patients who move from To start a benefits review or schedule sponsored by Bristol Myers Squibb, commercial to state or federal a call with a care coordination, visit but BMS Access Support can make healthcare program insurance will bmsaccesssupport.bmscustomer a referral to independent charitable no longer be eligible. To enroll, call connect.com/overview-services. foundations offering support for 1.855.SPRYCEL (1.855.777.9235), your specific patient. It is important Monday through Friday, 8:00 am to Sprycel Assist® to note that charitable foundations 8:00 pm ET. Sprycel Assist can do a benefits are independent from Bristol Myers review to assist in verifying Squibb Company. Each foundation 1-Month Free Trial coverage. If an insurer requires has its own eligibility criteria and For new eligible Medicare, prior authorization, Sprycel Assist evaluation process. Bristol Myers Medicaid, and cash-paying patients, can notify both the healthcare Squibb cannot guarantee that a patients must be new to Sprycel and provider and patient, they can patient will receive assistance. For have not previously filled a prescrip- provide pay-specific forms to the details, contact BMS Access Support tions for it. The free Trial may not provider’s office. For assistance, call at 1.800.861.0048. be redeemed on prescriptions written 1.855.SPRYCEL (1.855.777.9235), for longer than 30 days. Monday through Friday, 8:00 am to Sprycel Assist® 8:00 pm ET. With Sprycel Assist, co-pay assistance REIMBURSEMENT and support for eligible patients is ASSISTANCE available from day one. The Sprycel Assist patient support program BMS Access Support includes: Benefits Reviews • $0 co-pay offer for eligible com- BMS Access Support reviews patient mercially insured patients coverage for BMS medication.

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 33 Celgene Oncology

Celgene Oncology

Oncology-related products: Abraxane® (paclitaxel protein-bound particles for injectable suspension) (albumin-bound), Idhifa® (enasidenib) tablets, Inrebic® (fedratinib) capsules, Istodax® (romidepsin) for injection, Pomalyst® (pomalidomide) capsules, Reblozyl® (luspatercept-aamt) for injection, Revlimid® (lenalidomide) capsules, Thalomid® (thalidomide) capsules, Vidaza® (azacitidine for injection)

Patient and Reimbursement Assistance Website celgenepatientsupport.com

PATIENT ASSISTANCE limits) for Revlimid, Idhifa, prescribed Celgene medicine at no Inrebic, or Pomalyst cost. To qualify, patients must meet Celgene Patient Support® • $0 (subject to annual benefit certain financial criteria. It can also Celgene Patient Support cares about limits) for Reblozyl and Abraxane. help find other programs for which making sure patients get the answers patients may qualify to help pay for they need. That’s why specialists This program provides up to their medicine. To find out more, call are ready to help answer questions $10,000 per calendar year to help a Celgene Patient Support specialist about the insurance approval meet co-pay/co-insurance costs. at 1.800.931.8691, Monday through process, and the financial help that To be eligible, patients must have Friday, 8:00 am to 8:00 pm ET. may be available for a prescribed commercial or private insurance Celgene medicine. Celgene Patient that does not cover the full cost of Independent Support can help patients under- the prescribed Celgene medicine Third-Party Organizations stand the programs and services and reside within the United States For patients who have Medicare, Med- available. or U.S. territory. Patients with icaid, or other government-sponsored government healthcare insurance insurance, Celgene Patient Support To enroll, download the English or (for example, Medicare, Medicaid, can provide them with information Spanish enrollment form at celgene Medigap, TriCare, CHAMPVA) are about independent third-party orga- patientsupport.com/enrollment/. Fax not eligible. nizations that may be able to help the completed form to 1.800.822. patients with the cost of: 2496, or email it to patientsupport@ Other eligibility requirements and • Deductibles celgene.com, or submit the form restrictions apply. If eligible, patients • Co-payments/co-insurance online at celgenepatientsupport.com/ will be enrolled from the date of • Insurance premiums. enrollment/email-or-fax/. For more enrollment through the end of the information, call 1.800.931.8691. current calendar year. Financial and medical eligibility requirements vary by organization. Celegene Commercial Co-Pay Celgene Patient Assistance Program Program Transportation Assistance If patients have commercial insurance, If patients do not have health A Specialist can provide information they may qualify for this program. If insurance or enough coverage to about independent third-party they qualify, patients’ out-of-pocket pay for their medicine, the Celgene organizations that may be able to co-pay responsibility will be: Patient Assistance Program may help with travel costs to and from • $25 (subject to annual benefit be able to provide them with the the doctor’s office, including gas,

34 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 35 Celgene Oncology

tolls, parking, and taxi, bus, or train To enroll, download the English fare. Financial and medical eligibility or Spanish enrollment form at requirements vary by organization. celgenepatientsupport.com/ enrollment/email-or-fax/. Fax the REIMBURSEMENT completed form to 1.800.822.2496, ASSISTANCE or email it to patientsupport@ celgene.com, or submit the form Celgene Patient Support® online. For more information, call Specialists are available to assist 1.800.931.8691. with each of the following steps in the insurance approval process for prescribed Celgene medications.

Benefits Investigation Celegene Patient Support can initiate a benefits investigation to determine co-payment and other out-of-pocket costs, assess prior authorization or precertification requirements, and educate patients about insurance coverage or other programs for which they may qualify.

Prior Authorization/ Precertification Assistance A specialists can assist with the prior authorization or precertifi- cation process, process, providing the necessary forms for completion. They can also follow up with the insurance provider to determine the outcome.

Appeals Assistance If the patient’s insurance company denies a prior authorization, precer- tification, or claim for the prescribed Celgene medication, Celgene Patient Support can provide: • Information about the appeals process after a denied prior autho- rization, precertification, and/or claim • A checklist of the required docu- mentation for submission to the insurance company.

Celegene provides a facilitation service and will not provide any medical input into a prior authori- zation or an appeal.

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 35 Coherus BioSciences

Coherus BioSciences

Oncology-related product: Udenyca® (pegfilgrastim-cbqv)

Patient and Reimbursement Assistance Website coheruscomplete.com

PATIENT ASSISTANCE Part D, Veterans Affairs, the to 500 percent of the federal Department of Defense, or poverty level. Coherus COMPLETE™ TriCare Coherus COMPLETE provides a • Must not seek reimbursement This program also applies to suite of patient support services amount received from Coherus patients with government insurance and programs designed to remove from any third-party payers, who qualify. Enroll patients at reimbursement and access hurdles including flexible spending coheruscomplete.com. For any for Udenyca. accounts or healthcare savings questions, call 1.844.4.UDENCYA accounts. (1.844.483.3692). Coherus COMPLETE Co-Pay Assistance Program To enroll, visit copay.coheruscomplete. Charitable Foundations Coherus COMPLETE offers a com to log into the portal to apply. Coherus COMPLETE may also be Co-Pay Assistance Program that able to help patients find financial covers out-of-pocket expenses Patient Assistance Program support through charitable founda- related to Udenyca for commercially Udenyca can be provided at no cost tions. Patient access specialists can insured patients. Eligible patients to eligible uninsured and under- research alternative coverage options qualify for $0 out-of-pocket costs insured patients with financial for patients. When funding becomes for each Udenyca dose with an hardship through the patient assis- available, providers' practice will 180-day lookback period. The tance program. Patient eligibility receive email notifications alerting maximum annual benefit is $15,000. criteria: them to available funds from chari- Reimbursement is done via elec- • Uninsured or functionally table foundations. (1.844.483.3692). tronic remit; no physical co-pay card uninsured is required. • United States citizen or resident REIMBURSEMENT and must physically reside in the ASSISTANCE To be eligible for the Co-Pay U.S. or a U.S. territory Assistance Program, patients: • Be under the care of a U.S. Coherus COMPLETE™ • Must be prescribed Udenyca for licensed provider with an estab- Dedicated field reimbursement a medically appropriate use lished practice located in the U.S. managers and patient access spe- • Must have commercial health • Patients who appear to be cialists provide comprehensive insurance that covers the Medicaid eligible must have reimbursement support for your medication costs of Udenyca received a denial from Medicaid patients. • Must not be covered by any • Diagnosis and dosing must be federal, state, or govern- consistent with Udenyca’s FDA To contact your field reimbursement ment-funded healthcare program, approved label manager go to coheruscomplete.com such as Medicare, Medicaid, • Adjusted annual household or call 1.844.483.3692 Medicare Advantage, Medicare income of less than or equal

36 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 37 Daiichi Sanyko

Daiichi Sankyo

Oncology-related product: Turalio® (pexidartinib) capsules

Patient and Reimbursement Assistance Website turaliohcp.com/en/access-savings

PATIENT ASSISTANCE assistance on dates of service that Additional terms and conditions took place prior to enrollment. apply. Medicare enrollees may be Daiichi Sankyo Access eligible for this program if they are Centeral™ There are two simple ways to enroll: unable to meet their out-of-pocket Daiichi Sankyo Access Central 1. Fill out and fax the Patient costs for Turalio and meet the provides access and financial support Enrollment Form (dsiaccess- required income criteria. to patients who have been prescribed central.com/hcp/turalio) to Turalio. Biologics is the exclusive Biologics at 1.800.823.4506, To enroll, complete the Patient specialty pharmacy provider for and Biologics will complete the Enrollment Form (dsiaccesscentral. Turalio. Please fax the Patient enrollment process for eligible com/hcp/turalio), and fax it to Enrollment Form (dsiaccesscentral. patients. 1.833.471.9988 for patients’ eligi- com/hcp/turalio) and patients’ 2. Patients may also be enrolled bility to be assessed. You can also prescription directly to Biologics at online at: turalio.copaysaving- start the enrollment process over the 1.800.823.4506. sprogram.com/. phone by calling 1.800.850.4306.

Turalio Co-Pay Program If patients are eligible, Biologics Turalio Quickstart Program Eligible patients may pay as little will enroll them and call providers’ Patients experiencing a five-day as $0 per prescription, with a practice so that they can inform delay in getting their prescription maximum benefit of $25,000 per their patients of their enrollment. may be eligible for the Turalio calendar year. Patients must have An Access Central coordinator QuickStart Program. When filling commercial insurance coverage. may call providers’ practice to out the Patient Enrollment Form There are no income requirements address any issues with the copay (dsiaccesscentral.com/hcp/turalio), for eligibility. Patients partici- assistance enrollment process. For completing the optional Quick- pating in government healthcare questions about eligibility or the Start prescription section will help insurance programs are not eligible, enrollment process, call Biologics at expedite this process. To be eligible, including patients participating 1.800.850.4306. patients must: in Medicare, Medicaid, Medigap, • Be new to Turalio TriCare, Veterans Affairs (VA), Patient Assistance Program • Have commercial or government Department of Defense (DOD), or The Turalio Patient Assistance insurance any state-funded programs. In order Program may provide Turalio at no • Be experiencing a coverage delay to continue receiving copay assis- cost for financially eligible patients of five or more business days after tance, patients must reapply for the who are uninsured or underinsured. submission of a completed prior program each calendar year. Patients Patients must have been denied authorization. can enroll up to 30 days after their coverage, are uninsured, or are first Turalio treatment and utilize functionally uninsured (denied prior Additional terms and conditions a retroactive enrollment period for authorization, formulary exclusion). apply. Please note that QuickStart

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 37 Daiichi Sanyko

prescriptions cannot be shipped until both the physician and patient have completed the REMS requirements, including signing the REMS Patient Enrollment Form (www.turaliorems. com/#Main).

REIMBURSEMENT ASSISTANCE Daiichi Sankyo Access Central™ Daiichi Sankyo Access Central provides support and information to help patients access Turalio, which is available through Biologics. Fax the Patient Enrollment Form (dsiaccesscentral.com/hcp/turalio) and patients’ prescription directly to Biologics at 1.800.823.4506. Upon receiving the form, Biologics will be able to: • Conduct a benefits investigation • Help complete the prior authorization • Assist with enrollment into the Turalio Co-Pay Program for eligible commercially insured patients • Refer uninsured patients who may be eligible for the Turalio Patient Assistance Program to Daiichi Sankyo Access Central • Provide providers with a summary of benefits when requested.

Biologics is equipped to answer questions about Turalio prescrip- tions and patient support by calling 1.800.850.4306.

38 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 39 Daiichi Sanyko and Astra Zeneca

Daiichi Sanyko and Astra Zeneca

Oncology-related product: Enhertu®(fam-trastuzumab deruxtecan-nxki) injection for intravenous use

Patient and Reimbursement Assistance Website enhertu4u.com/hcp.html

PATIENT ASSISTANCE prescription. Patients who are • Not be receiving any other assis- enrolled in a state or federally funded tance to help pay for Enhertu ENHERTU4U prescription insurance program • Have an annual income at or Support options are available to help are not eligible. This includes below a certain level. patients who have been prescribed patients enrolled in Medicare Part Enhertu access their treatment. B, Medicare Part D, Medicaid, If patients are a Medicare beneficiary: Enroll today for help with: Medigap, Veterans Affairs (VA), • They must not be eligible for or • Affordability options Department of Defense (DoD) enrolled in Low Income Subsidy • Coding and reimbursement programs or TriCare, and patients (LIS) for Medicare Part D. • Distribution who are Medicare-eligible and • They must have spent at least • Nursing support. enrolled in an employer-sponsored three percent of their annual group waiver health plan or household income on prescription ENHERTU Patient Savings government-subsidized prescription medicines in the current year. Program drug benefit program for retirees. The goal of the Enhertu Patient If patients have experienced a Savings Program is to remove cost If patients meet eligibility require- life-changing event in the past as a barrier for eligible commercial ments, they can be enrolled online year, and their financial documen- patients by assisting with their (enhertusavings.com/auth/login) tation does not accurately reflect out-of-pocket costs. Eligible patients or by calling 1.833.ENHERTU their current situation, they are may pay as little as $0 per Enhertu (1.833.364.3788). If you need encouraged to apply to the Enhertu prescription, up to $26,000 per assistance enrolling a patient or Patient Assistance Program. They calendar year. The annual benefit have questions, please contact may still meet the criteria to enroll. can be used for the cost of the drug 1.833.364.3788. To enroll in the Enhertu Patient itself and may also cover up to $100 Assistance Program, complete the in infusion costs per administration. Patient Assistance Program enrollment form (enhertu4u.com/ There are no income requirements to This program is designed to help hcp/affordability.html) and fax it to participate in the program. Patients qualifying uninsured, underinsured, 1.833.904.1851. Once patients are who are residents of Massachusetts, or Medicare patients who are having enrolled in the program, a Product Michigan, Minnesota, or Rhode financial difficulty affording their Request Form (www.enhertu4u. Island are not eligible for infusion medication. The program provides com/hcp/affordability.html) must be assistance. Enhertu to qualifying patients at no completed for each prescription and cost. To be eligible for the program, refill to ensure accuracy of weight- Patients may be eligible for this patients must: based dosing of Enhertu. program they are insured by com- • Be a resident of the United States mercial insurance and their insurance • Not have insurance, private or For more information, call 1.833. does not cover the full cost of the government, that covers Enhertu ENHERTU (1.833.364.3788),

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 39 Daiichi Sanyko and Astra Zeneca

Monday through Friday, 9:00 am to temporary free supply if they expe- 6:00 pm ET. rience a coverage delay of greater than five business days. Independent Foundations Assistance may be available through Coding and Appeals independent foundations. Foun- Coding and appeals support are dations can provide a variety of available through ENHERTU4U. assistance types: co-pay, transpor- In some cases, payers may deny tation, premium, patient education, an initial claim for Enhertu. Fax a etc. These foundations are not completed enrollment form and the associated with AstraZeneca or explanation of benefits with reason Daiichi Sankyo; specific details and for denial to 1.866.760.5917 for eligibility requirements can be found assistance. directly at the foundations’ websites. If your claim is denied, the program RIEMBURSEMENT will provide you with the specific ASSISTANCE appeals requirements. You will need to provide a formal letter appealing ENHERTU4U the denial to the payer. For more Benefit Verification and Prior information, call 1.833.ENHERTU Authorization Assistance (1.833.364.3788). Specialists can help with benefit verification, prior authorization assistance, and pharmacy research and coordination. To request support for your patient, please complete and sign pages one and three of the patient enrollment form (enhertu4u.com/hcp/affordability. html) and fax it to 1.866.760.5917. A signature is required from both prescriber and patient. You can also call 1.833.ENHERTU (1.833.364.3788) to enroll patients over the phone.

Upon receiving a completed enrollment form, ENHERTU4U will complete the benefit verification within a business day and provide your office with the prior authori- zation requirements and required forms to obtain insurance approval for treatment. Once you submit the prior authorization, the program will follow up with your patient’s insurance company to ensure that they receive a coverage decision. Patients will be assessed for a

40 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 41 Eisai

Eisai Co., Ltd.

Oncology-related products: Halaven® (eribulin mesylate) injection, Lenvima® (lenvatinib) capsules

Patient and Reimbursement Assistance Website eisaireimbursement.com

PATIENT ASSISTANCE through Friday, 8:00 am to 8:00 To receive Lenvima through a pm ET to determine eligibility. specialty pharmacy and auto- Eisai Assistance Program matically enroll in all patient Eisai reserves the right, at its sole support services, complete the Eisai Patient Assistance discretion, to discontinue the Patient Lenvima Intake Form (http:// Program Assistance Program or change the www.eisaireimbursement.com/-/ Eisai has established the Patient qualifications at any time. All patient media/Files/XRay/Lenvima/ Assistance Program for patients information remains confidential. LENVIMA-Pan-Tumor-Intake- who need help paying for Lenvima. Product supply for the program Form.pdf) and fax the completed This program provides medications depends upon availability. form to identified specialty at no cost to uninsured and finan- pharmacy. cially burdened patients who meet $0 Co-Pay Program program eligibility criteria. Eligible, commercially insured For patients prescribed Halaven, patients prescribed Halaven or the completed enrollment form To enroll, complete the Lenvima Lenvima may pay as little as $0 (eisaireimbursement.com/-/media/ Eisai Assistance Program Enrollment per month. Depending on patients’ Files/XRay/Halaven/Halaven-0 Form (http://www.eisaireimbursement. insurance plan, they could have Copay-Enrollment-Form.pdf) com/-/media/Files/XRay/Lenvima/ additional financial responsi- must be submitted by fax to LENVIMA-Eisai-Assistance- bility for any amounts over Eisai’s 1.844.745.2350, including the Program-Enrollment-Form.pdf), and maximum liability. Limits vary patient and physician's signature. fax it to 1.855.246.5192. For more depending on the Eisai medication information, call 1.866.61.EISAI prescribed. Limits, include: If the patient is determined to be (1.866.613.4724), Monday through • For patients prescribed Halaven, eligible for the Halaven $0 Co-Pay Friday, 8:00 am to 8:00pm ET. the co-pay program provides up Program, they will be sent a welcome to $18,000 per year to assist with letter and a card. This card should be Halaven Patient Assistance out-of-pocket costs. given to the physician’s office so that Program • For patients prescribed Lenvima, it can be used to process the virtual Eisai has created the Halaven the co-pay program provides debit card payment. Fax the Expla- Patient Assistance Program for up to $40,000 per year to assist nation of Benefits (EOB) or detailed customers who need assistance with out-of-pocket costs. Specialty Pharmacy receipt for the paying for Halaven. This program Halaven claim to 844.745.2350. The provides Halaven at no cost to The program is not available to following information should patients who meet program eligi- patients enrolled in state or federal be included: bility criteria. Healthcare providers healthcare programs, including • Patient’s information including can call the program at 1.866.61. Medicare, Medicaid, Medigap, VA, full name EISAI (1.866.613.4724), Monday DoD, or TriCare. • Date of service

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 41 Eisai

• Cost of the medication • Amount covered by the insurance • Patient’s financial responsibility: deductible; co-payment; and co-insurance.

If the patient’s claim is approved, the appropriate funding based on the patient’s out-of-pocket costs will be loaded onto the patient’s card and a confirmation letter will be sent to the patient and the provider.

The card is solely intended to provide savings on any purchase of the approved Eisai medication. Use of the card for any one purchase does not obligate the patient to make future purchases of the same Eisai medication or any other product. For questions about the savings program, please call 1.866.61.EISAI (1.866.613.4724).

REIMBURSEMENT ASSISTANCE The Eisai Assistance Program For patients prescribed Halaven, Eisai can provide insurance verification, coverage options, information about the prior authorization process, and information about the claims and denials appeals process. Call 1.866.61.EISAI (1.866.613.4724) Monday through Friday, 9:00 am to 6:00 pm ET for all questions.

For Lenvima, patient support includes a benefit investigation to help patients understand their coverage. Call 1.866.61.EISAI (1.866.613.4724) or visit www.eisa- ireimbursement.com/hcp/lenvima/ accessing-lenvima for more infor- mation and to enroll patients.

42 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 43 Eli Lilly and Company

Eli Lilly and Company

Oncology-related products: Alimta® (pemetrexed) for injection, Cyramza® (ramucirumab) injection, Erbitux® (cetuximab) injection, Portrazza® (necitumumab) injection, Retevmo™ (selpercatinib) capsules, Verzenio® (abemaciclib) tablets

Patient and Reimbursement Assistance Websites lillyoncologysupport.com/ verzenio.com/hcp/savings-support retevmo.com/hcp/savings-support

PATIENT ASSISTANCE scribed Lilly Oncology medicine, up Download and print the Infused to a monthly cap of wholesale acqui- Products Enrollment Form (lilly- Lilly Oncology Support sition cost plus usual and customary oncologysupport.com/assets/pdf/ Center fees and a maximum of $25,000 patient_assistance_program_appli- Through the Lilly Oncology Support during a 12-month enrollment cation.pdf). Complete and fax the Center, Lilly strives to offer person- period. To be eligible, patients must: form to 1.877.366.0585. alized treatment support for eligible • Have been prescribed one of patients prescribed a Lilly Oncology the following Lilly Oncology Independent Patient product. For those who qualify, it medicines covered by the Assistance Program can help with: program—Alimta, Cyramza, Foundations • Understanding patients’ insurance Erbitux, or Portrazza The Lilly Cares Foundation, Inc., coverage • Have commercial insurance a separate nonprofit organization, • Review of financial-assistance that covers the prescribed Lilly offers a patient assistance program options, including savings card Oncology medicine, but does not to help qualifying patients receive programs and independent cover the full cost Lilly medications at no cost. For patient-assistance foundations • Be 18 years of age or older more information about Lilly Cares, • For some products it provides • Be receiving the prescribed please visit LillyCares.com. dedicated, personalized support medicine for an FDA-approved through every step of treatment. use Lilly Oncology Support Center • Be a resident of the United States can also provides information Lilly Oncology Infused Products or Puerto Rico. about a number of independent Co-Pay Program patient-assistance programs that Eligible, commercially insured Patients may not be participating may be able to help underinsured patients may qualify for savings in any state or federal healthcare patients get the treatment they need card assistance, which may help program, including, without lim- with less financial stress. These foun- patients manage treatment costs. itation, Medicaid, Medicare, dations are not affiliated with Eli Patients must first pay a portion of Medigap, DoD, VA, TriCare, or Lilly and Company and are operated their co-pay or coinsurance ($25 any state patient, or pharmaceutical independently. Funding availability for each dose of the prescribed Lilly assistance program; patients who changes weekly, so contact a Lilly Oncology medicine). The program move from commercial insurance to Oncology Support Center repre- will cover the remainder of patients' a state or federal healthcare program sentative at 1.866.472.8663 for the co-pay or coinsurance for the pre- will no longer be eligible. most recent updates.

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 43 Eli Lilly and Company

Verzenio Continuous including, without limitation, to a monthly cap of wholesale acqui- Care™ Medicaid, Medicare, Medicare Part sition cost plus usual and customary Verzenio Continuous Care provides D, Medigap, DOD, VA, TriCare, or pharmacy charges, and a separate various forms of support and any state patient or pharmaceutical $25,000 maximum annual cap. information to help patients access assistance program. Card activation Participation in the program requires Verzenio, which may include the is required. a valid patient HIPAA authori- following: zation. Patient is responsible for any • Benefits investigation support Digital cards can be downloaded applicable taxes, fees, or amounts • Co-pay savings and other financial online at verzenio.com/hcp/savings- exceeding monthly or annual caps. support support. This offer is invalid for patients • Ongoing support without commercial drug insurance • Field reimbursement support. MyRightDose or those whose prescription claims This dose exchange program may are eligible to be reimbursed, in The Verzenio Continuous Care simplify midcycle dose reductions whole or in part, by any govern- Program is not a guarantee of for patients and at no cost to them. mental program, including, without coverage. Terms and conditions Additional terms and conditions limitation, Medicaid, Medicare, apply for all programs. To enroll, apply. Medicare Part D, Medigap, DoD, complete and fax the Enrollment VA, TriCare/CHAMPUS, or any Form (verzenio.com/assets/pdf/ To apply for this program, complete state patient or pharmaceutical assis- hcp_enrollment_form.pdf) to the Dose Exchange Program tance program. 1.855.545.5957. In order to process Enrollment Form (verzenio. the requested services, Verzenio com/assets/pdf/MyRightDose_ To apply for the Retevmo Savings Continuous Care will require Enrollment_Form.pdf). Fax the Card, visit retevmo.com/savings- two patient signatures and a pre- completed form with prescriber support#savings-card or call scriber signature. Not signing the signature to 1.833.665.6329. 1.866.472.8663, Monday through Enrollment Form will result in an For more information, call Friday, 8:00 am to 10:00 pm ET to incomplete submission and a delay 1.833.557.2417, Monday through request a savings card. in requested services. Friday, 9:00 am to 6:00 pm ET or visit verzenio.com. Retevmo Interim Access For any questions, call Lilly Program Oncology Support Center at 1.844. Retevmo Support The Retevmo Interim Access VERZENIO (1.844.837.9364), Retevmo Support is tailored to Program may provide a temporary Monday through Friday, 8:00 am eligible patients' treatment journey. supply of Retevmo at no cost to to 10:00 pm ET. Retevmo Support programs and insured, eligible patients who have offerings are not a guarantee of been prescribed Retevmo for the first Verzenio Savings Card coverage. To enroll eligible patients time and are experiencing a delay in Eligible, commercially insured in all or any of these support their insurance coverage decision. patients pay as little as $0 a programs, call the Lilly Oncology This program is not available to month. Subject to a monthly cap of Support Center at 1.866.472.8663, patients whose insurers have made wholesale acquisition cost plus usual Monday through Friday, 8:00 am to a final determination to deny the and customary pharmacy charges 10:00 pm ET. patient coverage for Retevmo. If a and a separate $25,000 maximum denial is received after the initial annual cap. Patients are respon- Retevmo Savings Card five business days have passed and sible for any applicable taxes, fees, Eligible commercially insured appeal rights are being pursued, or amounts exceeding monthly or covered patients pay as little as $0 or if there is a persistent coverage annual caps. This offer is invalid a month. Offer is good for up to 12 delay, the patient, under appropriate for patients without commercial months until Dec. 31, 2021. Patients circumstances, may be eligible for up insurance coverage or those whose must have coverage for Retevmo to three additional 15-day supplies prescription claims are eligible to through their commercial drug of Retevmo. be reimbursed, in whole or in part, insurance to pay as little as $0 for a by any governmental program, 30-day supply of Retevmo, subject

44 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 45 Eli Lilly and Company

MyRightDose (1.844.837.9364), Monday through This dose exchange program may Friday, 8:00 am to 10:00 pm ET. simplify midcycle dose changes for patients. It ships the appropriate Retevmo Support dose directly to your patients’ Retevmo Support can provide home in as early as 48 hours and insurance and coverage assistance. at no cost to them. Additional A benefits investigation helps terms and conditions apply. To eligible, enrolled patients understand enroll patients, complete the their coverage options, locate the MyRightDose Enrollment Form appropriate specialty pharmacy, (retevmo.com/assets/pdf/dose-ex- and identify their lowest possible change-enrollment-form.pdf), and out-of-pocket cost, and a field fax it with the prescriber’s signature reimbursement manager helps to 1.844.372.9043. For more patients access prescribed Lilly information, call 1.833.290.2175, FDA-approved medicines. For more Monday through Friday, 9:00 am to information, call Lilly Oncology 6:00 pm ET, or visit retevmo.com. Support Center at 1.866.472.8663, Monday through Friday, 8:00 am to REIMBURSEMENT 10:00 pm ET. ASSISTANCE Oncology Support Center Through the Lilly Oncology Support Center, Lilly strives to offer individu- alized treatment support for eligible patients prescribed a Lilly Oncology product. For those who qualify, Lilly Oncology can help with reimbursement (eligibility determinations, benefits investigation, prior authorization assis- tance, and appeals information).

For questions or more information, call 1.866.472.8663, Monday through Friday, 8:00 am to 10:00 pm ET.

Verzenio Continuous Care™ Once enrolled in the Verzenio Continuous Care Program, patients will have access to a benefits investigation.

Benefits Investigation The program helps patients under- stand their coverage options, locate the appropriate pharmacy, and identify their lowest possible out-of-pocket cost.

For any questions, call Lilly Oncology Support Center at 1.844.VERZENIO

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 45 EMD Serono

EMD Serono, Inc.

Oncology-related product: Bavencio® (avelumab) injection

Patient and Reimbursement Assistance Website coverone.com

PATIENT ASSISTANCE Patient assistance is not applied retro- Enrolled patients may be eligible actively. A CoverOne representative to pay as little as a $0 co-pay for CoverOne® will notify patients and providers each treatment for Bavencio, up to Patient Assistance Program as soon as possible with patients’ a maximum of $30,000 per year. CoverOne provides patient access eligibility determination. Once the annual co-pay assistance and reimbursement support services limit is reached, enrolled patients are to help eligible patients gain appro- NOTE: The CoverOne patient assi- responsible for paying all co-pays priate access to Bavencio in the stance program is a philanthropic and any balance not covered by United States. program for patients in need and is CoverOne. not contingent on any past or future CoverOne recognizes that each commercial sale. Enrollment in the co–pay assistance patient’s situation is different and is program does not guarantee assis- dedicated to helping them one at a Co-Pay Assistance Program tance. Whether an expense is eligible time. For more information, contact CoverOne provides co-pay for the CoverOne Co-Pay Assis- 844.8COVER1 (844.826.8371), assistance for privately insured tance benefit will be determined at Monday through Friday, 8:00 am to Bavencio patients with co-pay/ the time the benefit is paid. Eligible 8:00 pm ET. co-insurance responsibilities who co-pay expenses must be in con- meet the program eligibility criteria. nection with a separately paid claim When Bavencio is used in com- for Bavencio administered in an bination with axitinib, questions Healthcare professionals may outpatient setting, which is related to reimbursement and access submit an application for co-pay otherwise covered by a private for axitinib may be referred to Pfizer assistance for their privately-in- or commercial insurance plan. Oncology TogetherTM at www.pfize- sured patients by submitting an roncologytogether.com/hcp. enrollment form through the REIMBURSEMENT CoverOne Enrollment Portal ASSISTANCE Patient Assistance Program (https://www.coverone.com/en/ CoverOne includes a patient portal/log-in.html) or by faxing CoverOne assistance program that provides a completed Enrollment Form CoverOne will help providers and Bavencio at no charge for patients who to 1.800.214.7295. CoverOne patients understand the specific meet certain income, insurance (i.e., is not permitted to offer co-pay coverage and reimbursement guide- uninsured), and residency eligibility assistance to any claims covered, lines for Bavencio. Reimbursement criteria. To determine patient eligibility, paid or reimbursed, in whole or in support services include: providers should complete a CoverOne part, by Medicaid, Medicare, or • Insurance benefit verification Enrollment Form on the CoverOne other federal or state healthcare • Prior authorization assistance Enrollment Portal (coverone.com/ programs. Full terms and conditions • Information on relevant billing en/portal/log-in.html) or fax it to for co-pay assistance can be found codes for Bavencio (HCPCS, CPT, 1.800.214.7295 prior to treatment. at coverone.com. ICD-10-CM, NDC)

46 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 47 EMD Serono

• Denied/underpaid claims assistance Active Listening 101 • Payer research (non-patient specific) • Medicare, private payers, state Medicaid. Active listening is a communication technique that requires the listener to feed back what is heard to the speaker by re-stating or paraphrasing Enroll patients through the what was heard in the listener’s own words. Active listening improves CoverOne Enrollment Portal personal relationships, reduces misunderstanding and conflicts, strengthens (www.coverone.com/en/portal/ cooperation, and fosters understanding. The skill is proactive, accountable, log-in.html), or fax a completed and professional. CoverOne Enrollment Form (www.coverone.com/en/Reim- Active listening is comprised of three primary elements: comprehension, bursement_support_services.html) to retention, and response. 1.800.7295 to request services. Comprehension—develop a shared meaning between parties through tone of voice, use of vocabulary and context, and speech pattern. EMD Serono, Inc. and Pfizer, Inc. Retention—take notes if necessary. do not guarantee coverage and/or reimbursement for Bavencio. Response—respond both verbally and non-verbally. Coverage, coding, and reim- bursement policies vary significantly Active Listening Tactics by payer, patient, and setting of • Listen and hear rather than waiting to speak. care. Actual coverage and reim- bursement decisions are made by • Watch body language. individual payers following the • Find common ground. receipt of claims. Patients and • Paraphrase the speaker’s words back to him or her as a question. healthcare professionals should (“I see/hear/feel like you are afraid of…”) always verify coverage, coding, and reimbursement guidelines on a payer • Suspend your own frame of reference and judgments. and patient-specific basis. • Validate what the speaker is saying and feeling (“You seem to feel angry, is that because…?”)

Barriers to Active Listening • Distractions • Trigger words • Vocabulary • Limited attention span • Emotions • Noise and visual distraction • Cultural differences • Interrupting or influencing

Source. ACCC Financial Advocacy Network. accc-cancer.org/FAN

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 47 Epizyme, Inc.

Epizyme, Inc.

Oncology-related product: Tazverik® (tazemetostat) tablets

Patient and Reimbursement Assistance Website tazverik.com/

PATIENT ASSISTANCE valid for cash-paying patients To be eligible, patients must: or patients currently enrolled in • meet Epizyme's financial eligibility EpizymeNOW Medicare, Medicaid, or any other requirements for enrollment in the To help facilitate access to Tazverik federal or state healthcare program. patient assistance program based for patients with a valid prescription, Limitations apply. To be eligible, on income and other supporting EpizymeNOW Patient & Product patients must: financial documentation Support can help patients under- • Currently have commercial • Reside in the United States, stand their insurance coverage and (private) health insurance that including U.S. territories identify any financial or product covers Tazverik • Have a valid prescription for support that may be available. All • Not have primary or secondary Tazverik patient support is subject to eligi- insurance coverage under any • Be currently uninsured or under- bility criteria and program terms state or federal health care insured based on insurance and conditions. program information verification. • Reside in the United States, To enroll patients in Epizy- including U.S. terrirtories Quick Start Program meNOW Patient and Product • Have a vaild presription for Patients may be eligible to receive Support, complete the enrollment Tazverik. their medication right away if they form (tazverik.com/Content/pdf/ experience a delay in the authori- patient-support-form.pdf) by Healthcare professionals and zation of prescription drug coverage checking all support options for pharmacy staff can enroll patients greater than five business days and which you are applying, and fax the into the co-pay program online at: their doctor has determined there is completed form to 1.877.542.2731. https://portal.trialcard.com/epizyme/. an immediate medical need to start For more information, call 1.833. treatment with Tazverik. If eligible, 4EPINOW (1.833.437.4669), Patient Assistance Program a 15-day supply (up to 60 days) of Monday through Friday, 9:00 am Patients may be eligible to receive Tazverik will be provided to patients to 6:00 pm ET. free medication if they are: until their prior authorization or • Uninsured coverage request is approved. Co-Pay Assistance Program • Underinsured (based on program For patients with commercial eligibility criteria) Bridge Supply Program (private) health insurance, they may • Enrolled in the Medicare Part Patients may be eligible to receive be eligible to receive co-payment D benefit and have coverage for a limited supply of free medication assistance to help reduce their Tazverik, but are currently expe- if they experience an unexpected out-of-pocket costs for Epizyme riencing financial hardship (based change or disruption in their pre- medications. Patients pay no more on Epizyme’s review of appro- scription drug coverage or supply than $10 per co-payment amount priate supporting documentation). (e.g., insurance provider requires a per prescription fill, with an annual new or updated prior authorization cap of $15,000. This offer is not or a change or loss of insurance).

48 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 49 Epizyme, Inc.

RIEMBURSEMENT ASSISTANCE EpizymeNOW EpizymeNOW provides resources to support patients’ access to Tazverik. Insurance related support includes benefit investigation, prior authori- zation, and appeal process support.

For insurance related support, enroll patients in EpizymeNOW Patient and Product Support by completing the enrollment form (tazverik.com/ Content/pdf/patient-support-form. pdf), checking all support options for which you are applying, and faxing the completed form to 1.877.542.2731. For more infor- mation, call 1.833.4EPINOW (1.833.437.4669), Monday through Friday, 9:00 am to 6:00 pm ET.

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 49 Exelixis

Exelixis, Inc.

Oncology-related products: Cabometyx® (cabozantinib) tablets, Cometriq® (cabozantinib) capsules

Patient and Reimbursement Assistance Websites ease.us cometriq.com/hcp/access/

PATIENT ASSISTANCE Program provides free medicine to more information, call 1.844.900. eligible patients who experience EASE (1.844.900.3273), Monday EASE Exelixis Access a payer decision delay of five through Friday, 8:00 am to 8:00 Services® days or more. Limited to on-label pm ET. Exelixis Access Services (EASE) indications. Additional restrictions provides a variety of support to help and eligibility rules apply. REIMBURSEMENT patients get started on treatment • The 15-Day Free Trial Program ASSISTANCE as soon as possible. EASE can provides free medicine to help meet the unique needs of patients patients start treatment quickly. EASE Exelixis Access and practices at each step along Limited to on-label indications. Services® the access journey. EASE offers Additional restrictions and eligi- At the provider's request, EASE can regionally dedicated case managers bility rules apply. provide support with: as a single point of contact. They • The Dose Exchange Program • Benefits investigation can provide the status of patients’ provides a free 15-day supply in • Prior authorization assistance access journey, offer prompt support the lower dose to help patients • Appeals support and follow-up. with payer coverage, financial assis- who require a dose reduction. tance, and treatment coordination, Additional restrictions and For more information, call and provide proactive follow-up. eligibility rules apply. 1.844.900.EASE (1.844.900.3273), EASE services include: Monday through Friday, 8:00 am to • The EASE $0 Co-Pay Program To apply for these services, 8:00 pm ET. ensures that eligible commercially download and complete the appro- insured patients pay $0 per month priate medication specific form This description of the Exelixis Access for a maximum benefit of $25,000 (Cabometyx: www.cometriq.com/ Services program is for informational per year. Additional restrictions downloads/COMETRIQ_EASE_ purposes only. Exelixis makes no and eligibility rules apply. Patients Enrollment_Form.pdf; Cometriq: representation or guarantee con- with government insurance are www.cometriq.com/downloads/ cerning reimbursement or coverage excluded. Visit activatethecard. COMETRIQ_EASE_Enrollment_ for any service or item. Information com/7311 to enroll eligible Form.pdf). Make sure to select provided through the Exelixis Access patients. the services for which patients are Services program does not constitute • The EASE Patient Assistance applying, and fax the completed medical or legal advice and is not Program helps eligible patients form to 1.844.901.3273. Patients intended to be a substitute for a con- who cannot afford their drug costs can also be enrolled into EASE sultation with a licensed healthcare receive their Exelixis medicines services using CoverMyMeds® provider, legal counsel, or appli- free of charge. Additional restric- (www.covermymeds.com/main/). cable third-party payer(s). Exelixis tions and eligibility rules apply. EASE will confirm patients’ eligi- reserves the right to modify the • The Cabometyx Quick Start bility for requested services. For program at any time without notice.

50 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 51 Genentech

Genentech, Inc.

Oncology-related products: Alecensa® (alectinib) capsules, Avastin® (bevacizumab) injection for IV use, Cotellic® (cobimetinib) tablets, Erivedge® (vismodegib) capsules, Gazyva® (obinutuzumab) injection, Herceptin® (trastuzumab) injection for intravenous use, Herceptin Hylecta™ (trastuzumab and hyaluronidase-oysk) injection, Kadcyla® (ado-trastuzumab emtansine) injection for intravenous use, Perjeta® (pertuzumab) for injection, Polivy® (polatuzumab vedotin-piiq) injection for intravenous use, Rituxan® (rituximab), Rituxan Hycela® (rituximab and hyaluronidase human) injection for subcutaneous use, Rozlytrek® (entrectinib) capsules, Tarceva® (erlotinib) tablets (co-marketed with Astella Pharma US, Inc.), Tecentriq® (atezolizumab) injection for intravenous use, Venclexta® (venetoclax) tablets, Zelboraf® (vemurafenib) tablets

Patient and Reimbursement Assistance Website genentech-access.com

PATIENT ASSISTANCE If one of these situations applies, • Receive a Genentech Oncology fax the completed enrollment product for an FDA-approved Genentech Access forms (gene.com/patients/ indication Solutions patient-foundation/apply-for-help) • Not participate in a federal or The Genentech Patient to 833.999.4363. You can expect to state-funded healthcare program, Foundation hear from a foundation specialist to such as Medicare, Medicaid, The Genentech Patient Foundation let you know if the application was Medigap, VA, DoD, or TriCare gives free Genentech medicine to approved or if more information • Be 18 years of age or older, or people who don’t have insurance is needed. Once the application have a legal guardian 18 years coverage or who have financial is approved, the foundation will of age or older to manage the concerns. Patients qualify if they: send the Genentech medicine to the program • Are uninsured with incomes under patient or the healthcare provider’s • Live in and receive treatment $150,000 office as directed on the form as in the United States or U.S. • Are insured without coverage quickly as possible. territories for a Genentech medicine with • Not be receiving assistance incomes under $150,000 For more information, call through the Genentech Patient • Are insured with coverage for a 888.941.3331, Monday through Foundation or any other co-pay Genentech medicine, with unaf- Friday, 6:00 am to 5:00 pm ET. charitable organization. fordable out-of-pocket costs, who have pursued other forms Genentech Oncology® Co-pay There are no income requirements. of financial assistance, and with Assistance Program Patients pay as little as $5 for their household size and income within This co-pay assistance program prescribed Genentech Oncology certain guidelines. (Guidelines helps eligible patients pay for pre- products with an annual benefit are available at www.gene.com/ scription medication costs. In order limit of $25,000 per product. The patients/patient-foundation/ to qualify for the program, patients $5 co-pay applies to FDA-approved see-if-you-qualify). must meet the following criteria: Genentech combination products. • Be covered by commercial or Retroactive requests for assistance private insurance may be honored for qualifying

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 51 Genentech

patients if the infusion or pre- to help determine if a Genentech plan’s guidelines to determine scription fill occurred within 180 medicine is covered, if prior authori- what to include in the patient’s days prior to enrollment and the zations are required, which specialty appeal submission patient meets all eligibility criteria pharmacy the health insurance plan • A field reimbursement manager at the time of infusion. No physical prefers, and if patient assistance or Access Solutions specialist has card is needed; patients simply need might be needed. The potential local payer coverage expertise their Member ID. outcomes of a BI are: and can help determine specific • Treatment is covered requirements for the patient. Please note: Co-pay assistance for • Prior authorization is required patients who are enrolled in the • Treatment is denied. Sample letters and additional co-pay program for Tarceva will be considerations are available ending effective December 15th, 2020. Both the Prescriber Service Form at genentech-access.com by and the Patient Consent Form must selecting the prescribed medi- To get started, visit copayassistan- be received before Genentech Access cation and selecting the “Forms cenow.com. For questions about Solutions can begin helping patients. and Documents” section. Appeals this program, call 855.MY.COPAY Forms can be found by going to cannot be completed or submitted (855.692.6729), Monday through genentech-access.com, selecting the by Genentech Access Solutions on Friday, 9:00 am to 8:00 pm ET. prescribed medication, and selecting providers’ behalf. the “Forms and Documents.” Referrals to Independent They can be submitted via fax to My Patient Solutions Co-pay Assistance Foundations 888.249.4919 or online via My My Patient Solutions is an online An independent co-pay assistance Patient Solutions (genentech-access. tool to help enroll patients in foundation is a charitable organi- com/hcp/my-patient-solutions.html). Genentech Access Solutions and zation providing financial assistance manage service requests. Log in or to patients with specific disease Prior Authorization Assistance register (www.genentech-access.com/ states. Genentech Access Solutions Genentech Access Solutions can hcp/my-patient-solutions.html) with offers referrals to independent help identify if a prior authorization My Patient Solutions to: co-pay assistance foundations for is necessary and offer resources as • Enroll and re-enroll patients eligible patients who are commer- healthcare professionals obtain for • Communicate with a Genentech cially or publicly insured, including patients. Both the Prescriber Service Form Access Solutions specialist those covered by Medicare and and the Patient Consent Form must • See which service requests require Medicaid. Genentech does not be received before Genentech Access action influence or control the opera- Solutions can begin helping patients. • Co-pay assistance details tions or eligibility criteria of any • View benefits investigation reports independent co-pay assistance foun- If the request for a prior authorization • Follow up on prior authorizations dation and cannot guarantee co-pay is not granted, your BioOncology or appeals assistance after a referral. field reimbursement manager or • Request benefits reverifications. Genentech Access Solutions spe- To get started, visit genentech-access. cialist can work with providers to Account registration can be com, select the prescribed medication, determine next steps. completed by one person for the and follow instructions to apply for entire practice and for multiple this assistance. Appeals practice locations at https:// If patients’ health insurance plan has genentech-prod.force.com/ihcp/ REIMBURSEMENT issued a denial, a BioOncology field GNE_CM_PACT_Login#!/. For ASSISTANCE reimbursement manager or Access assistance, call 866.422.2377, Solutions specialist can provide Monday through Friday, 6:00 am to Genentech Access resources providers prepare an appeal 5:00 pm ET. Solutions submission per patients’ plan require- Benefits Investigation ments If a plan issues a denial: Genentech Access Solutions can • The denial should be reviewed, conduct a benefits investigation (BI) along with the health insurance

52 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 53 GlaxoSmithKline

GlaxoSmithKline

Oncology-related product: Blenrep (belantamab mafodotin-blmf) for injection, Zejula® (niraparib) capsules

Patient and Reimbursement Assistance Website togetherwithgskoncology.com

PATIENT ASSISTANCE Commercial Co-pay Program Patient Assistance Program Eligible, commercially insured Uninsured patients and those whose Together with GSK patients could pay as little as $0 insurance does not cover their Oncology for their medicine. Download and prescribed medication (including Together with GSK Oncology offers complete the Together with GSK Medicare), and who meet eligibility patients and healthcare profes- Oncology enrollment form for with requirements may access medication sionals a variety of access and the patient to submit for approval. free of charge through GSK's patient reimbursement services for all GSK Terms and Conditions apply. assistance program. oncology products—all in one place. Patients may be eligible based on To qualify for the patient assistance To enroll, complete the enrollment general criteria below: program patients must: form for the prescribed medication • Have a commercial medical or • Live in one of the 50 states, (www.togetherwithgskoncology. prescription insurance plan or are District of Columbia, Puerto Rico, com/hcp-resources/). Select services uninsured or U.S. Virgin Islands requested from the program and • Are a resident of the United • Meet one of these criteria: complete all patient and prescriber States (including the District of • Uninsured information. Make sure that both Columbia, Puerto Rico, and the • Have private commercial the patient and prescriber sign the U.S. Virgin Islands) insurance but have no coverage form. Fax the completed form, plus • Are not eligible for or enrolled in (medical or pharmacy) for the copies of the patient’s medical and a government funded program. product as demonstrated to the pharmacy insurance cards, to the program through the defined number listed on the form. If the patient is approved, the appeals process criteria (please Together with GSK Oncology contact program for details) Together with GSK Oncology will Commercial Co-pay Program may • Not be currently receiving pre- contact the prescriber’s office by the help with patient’s cost share for scription drug coverage through a next business day—and will conduct a GSK Oncology product and the government Program (excluding a summary-of-benefits call with the cost of administration, up to $100 Medicare), which includes Medicaid, patient within two business days. per administration for IV products, VA, DOD or TriCare benefits up to a program total of $26,000 • Not be eligible for Puerto Rico's For more information, call 1.844. annually. Residents of Massachusetts, Government Health Plan Mi 4.GSKONC (1.844.447.5662), Michigan, Minnesota, or Rhode Salud, or have applied and been Monday through Friday, 8:00 am Island are not eligible for reim- denied to 8:00 pm ET. bursement of administration fees. • Meet certain income eligibility Eligibility in the program is for one requirements. Patients whose year. Patients must apply for co-pay income exceeds program eligibility assistance each year that they wish maximum will be provided the to participate in the program. opportunity to demonstrate that

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 53 GlaxoSmithKline

their eligible medical expenses bring them within the income eligibility criteria (please contact program for details).

For more information, call 1.844.4GSKONC (1.844.447.5662).

Quick Start and Bridge Program For patients experiencing delay in coverage for Zejula at first dispense (Quick Start), or coverage interrup- tions while already on treatment (Bridge), download and fill out the Zejula enrollment form (www. togetherwithgskoncology.com/ hcp-resources/zejula/). Fax the completed form to 1.800.645.9043.

RIEMBURSEMENT ASSISTANCE Together with GSK Oncology For healthcare professionals—and their patients—Together with GSK Oncology offers: • Patient-specific benefits investigation • Prior authorization and appeals support • Claims assistance.

Together with GSK Oncology can provide practices with assistance for claims submissions, including providing examples of forms and sample letters, outlining payer-specific information.

For more information, call 1.844. 4.GSKONC (1.844.447.5662), Monday through Friday, 8:00 am to 8:00 pm ET.

54 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 55 Immunomedics

Immunomedics

Oncology-related product: Trodelvy™ (sacituzumab govitecan-hziy) for injection

Patient and Reimbursement Assistance Website enhertu4u.com/hcp.html

PATIENT ASSISTANCE To enroll a patient, complete the co-pay assistance foundation. If Enrollment Form (https://trodelvy. co-pay assistance needs are iden- Trodelvy Access Services com/hcp/access-services), check tified, the case managers can provide Trodelvy access services is a patient the “refer patient to TRODELVY information about any available access and reimbursement support Savings Program” box, and fax it to foundations. The foundation will program. It will help healthcare 1.833.851.4344. determine patients’ eligibility for providers and their patients co-pay or co-insurance assistance understand specific coverage and Immunomedics Patient based on their own criteria and, reimbursement guidelines for Assistance Program completely independent of Immuno- Trodelvy. Patient access support Patients who are uninsured or medics and its agents, will contact includes: underinsured may be eligible to the patient directly regarding the • Trodelvy savings program obtain access to Trodelvy at no application process. Immunomedics • Immunomedics patient assistance cost through the Immunomedics and its agents make no guarantee program Patient Assistance Program. To regarding reimbursement for any • Referrals to independent third- qualify for assistance, patients must service or item. party assistance organizations. meet certain eligibility criteria. To determine patient eligibility, fax REIMBURSEMENT To enroll a patient, complete a completed program Enrollment ASSISTANCE the Enrollment Form (https:/ Form (https://trodelvy.com/pdf/PAP_ trodelvy.com/hcp/access-services) Enrollment.pdf) to 1.833.851.4344. Trodelvy Access Services with the patients, and fax it to Trodelvy access services is a patient 1.833.851.4344. For further For more information regarding access and reimbursement support information, contact the the program, contact 1.844. program. Reimbursement support program at 1.844.TRODELVY TRODELVY (1.844.876.3358). services include: (1.844.876.3358), Monday through • Coverage verification Friday, 9:00 am to 7:00 pm ET. Independent Third-Party • Prior authorization information Assistance Organizations • Claims status information Trodelvy Savings Program Patients with Medicare or other • Billing and coding information Once enrolled the patient pays $0 government insurance who need • Alternate assistance options. out-of-pocket for Trodelvy with assistance with cost-share require- maximum benefit of $25,000 per ments for Trodelvy may be eligible Coverage, coding, and billing year. Patients must meet certain for co-pay or co-insurance assis- requirements for Trodelvy may eligibility criteria to qualify for tance through an independent vary by plan and patient. For this program. The program is not co-pay assistance foundation. Case further information, contact the available to patients with any form managers can help patients assess program at 1.844.TRODELVY of government insurance. their high-level eligibility for possible (1.844.876.3358), Monday through coverage through an independent Friday, 9:00 am to 7:00 pm ET.

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 55 Incyte Corporation

Incyte Corporation

Oncology-related product: Jakafi® (ruxolitinib) tablets, Pemazyre® (pemigatinib) tablets

Patient and Reimbursement Assistance Website incytecares.com

PATIENT ASSISTANCE • Offer financial assistance options Amount of savings on Pemazyre will for which the patient may be not exceed $9,000 per claim and IncyteCARES eligible $25,000 per year. IncyteCARES helps eligible • Explain other resources and patients access their prescribed support available to the patient To enroll, contact IncyteCARES at Incyte medications and offers during treatment. 1.866.708.8806 or apply online for information and resources that Jakafi https://sservices.trialcard.( provide extra support during For additional help, call 1.855. com/Coupon/incyte) or Pemazyre treatment. Its team is available 452.5234, Monday through Friday, (https://portal.trialcard.com/ to patients and their caregivers 8:00 am to 8:00 pm ET. pemazyre/). by phone every weekday. It helps eligible patients with: Copay/Coinsurance Program Patient Assistance Program • Reimbursement support Eligible patients can receive their The IncyteCARES Patient Assis- • Delivery coordination medication for as little as $0 per tance Program helps eligible patients • Financial assistance options month, subject to monthly and who do not have prescription • Temporary access for coverage annual limits. To qualify, patients drug insurance or who have an delays must: insurance plan that will not cover • Connection to support resources • Have commercial or private their treatment. Eligible patients can • Education and helpful resources. prescription drug coverage receive medication free of charge. • Be a resident of the United States Terms of program may change at To enroll, complete and submit the or a U.S. territory any time. medication-specific enrollment form • Have a valid prescription for at incytecares.com or through the an Incyte medication for an To qualify, patients must: online portal (https://hcp.incytecares. FDA-approved use. • Be a resident of the United States com/jakafi/enrollment/informa- or a U.S. territory tion-patient.aspx) for patients Patients insured under federal or • Have a valid prescription for prescribed Jakafi. Completed state government prescription drug an Incyte medication for an hard-copy forms should be faxed to programs—including Medicare Part FDA-approved use the number indicated on the form. D, Medicare Advantage, Medicaid, • Meet certain household size and Once an eligible patient is enrolled, or TriCare—are not eligible. Patients annual income criteria. an IncyteCARES representative will: without prescription drug coverage • Review coverage and costs for the are also not eligible. Patients with prescription coverage prescribed medication through government programs, • Coordinate patients’ prescription Amount of savings for the purchase including Medicare Part D, Medicare and monthly delivery with an of Jakafi will not exceed $11,977 Advantage, Medicaid, TriCare, or appropriate specialty pharmacy per month and $25,000 per year. by a health care exchange plan are

56 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 57 Incyte Corporation

not eligible. Patients must first be If patients do not qualify for the enrolled in IncyteCARES. Within IncyteCARES Copay/Coinsurance two business days of receiving Program or patient assistance the enrollment form, patients are program, IncyteCARES may be notified of “conditional approval” able to provide information about for the program. This allows them to other organizations or independent receive free medication for 90 days. foundations that may offer help. Full approval is only granted once Some assist with medication costs, income information is submitted and transportation or lodging expenses confirmed. related to treatment, or counseling services, offered at reduced or no Temporary Access Program cost. Eligibility and availability Eligible patients receive a free of these assistance programs are short-term supply of medication. determined by the individual If a patient’s prescription drug organizations. insurer requires more than a three-day wait for determining RIEMBURSEMENT coverage approval, IncyteCARES ASSISTANCE may be able to provide a free short-term supply of the prescribed IncyteCARES Incyte medication in the meantime. IncyteCARES’ mission is to help No purchase contingencies or eligible patients access their pre- other obligations apply. To qualify, scribed IncyteCARES medications patients must: and to offer information and • Have commercial or private resources that provide support prescription drug coverage or a during treatment. healthcare exchange plan. • Be a resident of the United States For eligible patients, IncyteCARES or a U.S. territory can provide benefits verification • Have a valid prescription for and as-needed prior authorization an Incyte medication for an or appeal support. For more infor- FDA-approved use mation, call 1.866.708.8806, • Provide proof of the coverage Monday through Friday, 8:00 am delay. This may be a notice to 8:00 pm ET or visit www.incyte- providers or patients receive from cares.com/. the insurance company.

Patients insured under federal or state government prescription drug programs, including Medicare Part D, Medicare Advantage, Medicaid, or TriCare, are not eligible. Patients without prescription drug coverage are also not eligible.

Independent Foundations Patients may be eligible for help with medication, treatment-related travel, and other costs.

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 57 Ipsen

I psen Biopharmaceuticals, Inc.

Oncology-related products: Onivyde® (irinotecan liposome) injection, Somatuline® Depot (lanreotide) injection

Patient and Reimbursement Assistance Website ipsencares.com

PATIENT ASSISTANCE 3. By calling a patient access spe- Patient Assistance Program cialist at 866.435.5677. The patient assistance program is IPSEN CARES® designed to provide Ipsen medica- The IPSEN CARES (Coverage, IPSEN CARES tions at no cost to eligible patients. Access, Reimbursement & Copay Assistance Program Patients may be eligible to receive Education Support) serves as a Most eligible patients with private free medication if they are experi- central point of contact between insurance pay no copay subject to a encing financial hardship, have no patients, caregivers, doctors’ offices, maximum annual benefit of $20,000. insurance coverage, and received a insurance companies, and specialty For Somatuline Depot, the program prescription for on-label use of an pharmacies. Patient access specialists exhausts after 13 injections, or a Ipsen medication. Eligibility does not will check each patient’s pharmacy maximum annual benefit of $20,000, guarantee approval for participation and medical benefits to determine whichever comes first. Cash-pay in the program. if the medicine is covered for the patients are eligible to participate. indication the treating physician For cash-pay patients, the maximum Providers can help patients enroll in has specified. If there are any copay benefit amount per pre- three ways: restrictions, IPSEN CARES will scription is $1,666.66, subject to the 1. Through the online provider inform the doctor about the addi- annual maximum of $20,000 in total. portal at https://ipsencaresportal. tional information required by the Patient pays any amount greater than biologicsinc.com/Account/Login insurance company for the doctor’s the maximum copay savings amount 2. By printing a medication-specific completion. A summary of all the per prescription. Patients must enroll downloadable PDF to be filled out information collected will be sent every 12 months from date of accep- and faxed to 1.888.525.2416 back to the doctor’s office in a single tance to receive a continued benefit. 3. By calling a patient access spe- document. IPSEN CARES offers the cialist at 866.435.5677. following services services: Patients are not eligible for copay • Reimbursement assistance assistance through IPSEN CARES For further assistance, call • Financial Support if they are enrolled in any state or 1.866.435.5677, Monday through • Patient support. federally funded programs for which Friday, 8:00 am to 8:00 pm ET. drug prescriptions or coverage could Providers can help patients enroll in be paid in part or in full, including, REIMBURSEMENT three ways: but not limited to, Medicare Part ASSISTANCE 1. Through the online provider B, Medicare Part D, Medicaid, portal at https://ipsencaresportal. Medigap, VA, DoD, or TriCare (col- IPSEN CARES biologicsinc.com/Account/Login lectively, “Government Programs”), IPSEN CARES offers the following 2. By printing a medication-specific or where prohibited by law. For reimbursement assistance services: downloadable PDF to be filled out more information, visit www.ipsen- • Benefits Verification: Ipsen and faxed to 1.888.525.2416 cares.com/ or call 866.435.6577. CARES verifies patients’ coverage,

58 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 59 Ipsen

restrictions (if applicable), and copayment/coinsurance amounts. • Prior Authorization: IPSEN CARES provides information on documentation required by payers on prior authorization specifics and makes recommendations for next steps based on payer policy. • Appeals Information: IPSEN CARES provides information on the payer-specific processes required to submit a level I or a level II appeal, as well as provides guidance as needed throughout the process.

Visit ipsencares.com for more information or call 866.435.5677, Monday through Friday, 8:00 am to 8:00 pm ET.

2018–2019 Federal Poverty Guidelines* Family Size 100% 133% 138% 250% 400%

1 $12,140 $16,146 $16,753 $30,350 $48,560

2 $16,460 $21,892 $22,715 $41,150 $65,840

3 $20,780 $27,637 $28,676 $51,950 $83,120

4 $25,100 $33,383 $34,638 $62,750 $100,400

5 $29,420 $39,129 $40,600 $73,550 $117,680

6 $33,740 $44,874 $46,561 $84,350 $134,960

7 $38,060 $50,620 $52,523 $95,150 $152,240

8 $42,380 $56,365 $58,484 $105,950 $169,520

* Federal poverty level amounts are higher in Alaska and Hawaii.

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 59 Janssen

Janssen Biotech, Inc.

Oncology-related products: Balversa™ (erdafitinib) tablets, Darzalex® (daratumumab) injection for intravenous use, Darzalex Faspro™ (daratumumab and hyaluronidase-fihj) injection for subcutaneous use, Erleada® (apalutamide) tablets, Procrit® (epoetin alpha) injection, Yondelis® (trabectedin) for injection, Zytiga® (abiraterone acetate) tablets

Patient and Reimbursement Assistance Website JanssenCarePath.com

PATIENT ASSISTANCE or deductible. This program is maximum program benefit per only available to individuals using calendar year or one-year supply, Janssen CarePath commercial or private health whichever comes first. Janssen CarePath is the one source insurance for their Janssen medi- • For Zytiga, eligible patients pay for access, affordability, and cation, including plans available $10 per month with a $12,000 treatment support for patients. through state and federal healthcare maximum program benefit per Janssen CarePath helps verify exchanges. This program is not calendar year or one-year supply, insurance coverage for patients, available to individuals who us any whichever comes first. provides reimbursement infor- state or federal government-funded mation, helps find financial healthcare programs to cover a To learn more about the Janssen assistance options for eligible portion of medication costs, such CarePath Savings Program, patients, and provides ongoing as Medicare, Medicaid, TriCare, including full eligibility require- support to help patients start Department of Defense, Veterans ments, visit www.janssencarepath. and stay on prescribed Janssen Administration. Terms expire at com/hcp, select the prescribed medi- medications. the end of each calendar year and cation, see affordability options. For may change. There is no income patients prescribed Balversa, visit Eligible patients can be enrolled requirement. www.balversa.com/support- through the Janssen CarePath resources/cost-support for more provider portal at janssencarepath- Savings for Janssen medicines, information. portal.com. For questions, call include: 877.CarePath (877.227.3728), • For Balversa, eligible patients will Other Affordability Options Monday through Friday, 8:00 am pay $5 per fill with a $25,000 For patients using government-funded to 8:00 pm ET. maximum program benefit per healthcare programs or without calendar year. health coverage, Janssen CarePath Janssen CarePath Savings • For Darzalex, Darzalex Faspro, can provide information about other Program and Yondelis, eligible patients will resources that may be able to help The Janssen CarePath Savings pay $5 per dose with a $20,000 patients with their out-of-pocket Program can help eligible patients maximum program benefit per medication costs. receive instant savings on their calendar year. The program out-of-pocket costs for their Janssen does not cover costs to give the Independent co-pay assistance medicine. Depending on their treatment. foundations have their own rules health insurance plan, savings may • For Erleada, eligible patients pay for eligibility. Janssen has no control apply toward co-pay, co-insurance, $0 per month with a $15,000 over these independent founda-

60 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 61 Janssen

tions and can only refer patients • Review and explain patients’ insur- to a foundation that supports their ance coverage and out-of-pocket disease state. Janssen does not costs for Janssen medications endorse any particular foundation. • Help identify financial assistance options for eligible patients. JanssenPrescription Assistance.com Janssen CarePath Provider Call Janssen CarePath at 877. Portal CarePath (877.22.-3728) or visit The Provider Portal gives you JanssenPrescriptionAssistance.com 24-hour online access to request for more information on affordability and review benefits investigations, programs that may be available. provide prior authorization support and status monitoring, and enroll Johnson & Johnson Patient eligible patients in the Janssen Assistance Foundation CarePath Savings Program. The Johnson & Johnson Patient Assistance Foundation, Inc. (JJPAF) Create a Provider Portal account is an independent, nonprofit organi- at JanssenCarePathPortal.com. For zation that is committed to helping any questions, contact 877.CarePath eligible patients without insurance (877.227.3728), Monday through coverage receive prescription Friday, 8:00 am to 8:00 pm ET. products donated by Johnson & Johnson operating companies. Janssen CarePath Account To see if your patient might qualify Patients and caregivers can create for assistance, please contact a JJPAF an online account at MyJanssen- program specialist at 800.652.6227, CarePath.com for 24-hour/365-day Monday through Friday, 9:00 am to access to learn about their insurance 6:00 pm ET, or visit the foundation coverage, enroll in the Janssen website at www.JJPAF.org. CarePath Savings Program if eligible, manage their savings program REIMBURSEMENT benefits, and sign up for person- ASSISTANCE alized treatment reminders. Janssen CarePath Janssen CarePath helps verify insurance coverage for patients, provides reimbursement information, helps find financial assistance options for eligible patients, and provides ongoing support to help patients start and stay on prescribed Janssen medications.

What Janssen CarePath can do on behalf of your patients: • Provide support with dedicated care coordinators for providers and patients • Conduct benefits investigations and provide insurance coverage information

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 61 Jazz Pharmaceuticals

Jazz Pharmaceuticals

Oncology-related products: Defitelio® (defibrotide sodium) injection, Erwineaze® (asparaginase Erwinia chrysanthemi) for injection, Vyxeos® (daunorubicin and cytarabine) liposome for injection, Zepzelca®(lurbinectedin) for injection

Patient and Reimbursement Assistance Website jazzcares.com/hcp

PATIENT ASSISTANCE This program is only available for REIMBURSEMENT eligible patients prescribed Vyxeos ASSISTANCE JazzCares™ or Zepzelca. For more information, The JazzCares Program is sponsored call JazzCares at 1.888.533.5299. JazzCares™ by Jazz Pharmaceuticals to help To help patients get access to their improve access to Jazz products Free Drug Program prescribed Jazz medicines, JazzCares for appropriate patients. Dedicated Eligible patients who are uninsured specialists are available to: JazzCares specialists are available or who are deemed uninsured due • Investigate benefits and verifies to assist patients and practices with to lack of coverage for their pre- patient coverage coverage and reimbursement support scribed medicine may receive their • Provide prior authorization and for their prescribed medicines. Jazz product at no cost. Subject appeals support The JazzCares Program includes: to financial and residency eligi- • Answer coding and other reim- • Help understanding insurance bility criteria. For full eligibility bursement questions coverage requirements and to apply for • Refers patients to financial assis- • Help commercially insured patients prescribed Zepzelca, visit tance options. patients with paying for their jazzcares.com/zepzelca.html#hcp, medication and complete the patient assis- Get started with JazzCares • Free-drug program for eligible tance application by faxing it to support by calling its hotline at patients 1.855.593.3955. For all other oncol- 1.888.533.5299, Monday through • Referrals to other financial ogy-related products, call JazzCares Friday, 8:00 am to 8:00 pm ET. assistance options. at 1.888.533.5299, Monday through Friday, 8:00 am to 8:00 pm ET for To speak with a JazzCares represen- more information. tative, call 1.888.533.5299, Monday through Friday, 8:00 am Other Financial Assistance to 8:00 pm ET. Options JazzCares can also refer patients to Savings Card third-party organizations that may This program provides eligible, be able to offer financial assistance commercially insured patients with for the cost of medication. assistance for out-of-pocket costs for their prescribed Jazz medicines, subject to an annual maximum.

62 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 63 Karyopharm Therapeutics

Karyopharm Therapeutics

Oncology-related product: Xpovio® (selinexor) tablets

Patient and Reimbursement Assistance Website karyforward.com

PATIENT ASSISTANCE • Patient has commercial (private) receive Karyopharm medications at insurance that covers Xpovio no cost. In order to be eligible for KayForward® • Patient has a valid prescription for the program, patients must: KaryForward is a patient support Xpovio that is consistent with an • Be a resident of the United States program dedicated to providing approved indication. or its territories and be under the assistance and resources to patients care of a licensed healthcare pro- and their caregivers for Karyopharm Patients are not eligible if they are fessional authorized to prescribe, medications, including insurance uninsured or if they participate dispense, and administer medicine coverage, financial assistance, and in any federal or state healthcare in the U.S. resources and support. program, including without lim- • Be uninsured or underinsured or itation, Medicare, Medicaid, lack coverage for the prescribed All support and programs are TriCare, and Veterans Health therapy subject to eligibility requirements. Administration. This offer is not • Have an annual household income To enroll, download and complete valid for cash-paying patients, where that does not exceed the greater the KaryForward Enrollment Form Xpovio is not covered by patients’ of $100,000 or 800 percent of the (www.karyforward.com/pdf/karyfor- commercial insurance, or where current Federal Poverty Level (FPL). ward-enrollment-form.pdf), check the plan reimburses patients for the all services the patient is applying entire cost of the medication. Karyo- To enroll patients in KaryForward for, and fax the completed form to pharm Therapeutics reserves the Patient Assistance Program, download 1.833.589.1603. For more infor- right to rescind, revoke, amend, or and complete the Enrollment Form mation, call 1.877.KARY4WD terminate this offer or the program (www.karyforward.com/pdf/kary- (1.877.527.9493), Monday through in its entirety at any time. forward-enrollment-form.pdf), mark Friday, 8:00 am to 8:00 pm ET. the “Patient Assistance Program,” To enroll patients in the program, and fax the completed form to Xpovio Copay Program apply online at https://qv.trialcard. 1.833.589.1603. This offer allows eligible patients com/xpovio#/app/layout/home with commercial insurance to pay or download and complete the Alternate Sources of Coverage as little as $5 per month, with a KaryForward Enrollment Form If patients do not meet the eli- maximum of $8,000 per 30-day (www.karyforward.com/pdf/karyfor- gibility criteria for the co-pay prescription and up to a maximum ward-enrollment-form.pdf), check program or patient assistance total of $25,000 per calendar year. the “Copay Program” circle, and fax program and still need assistance, The program will cover the copay the form to 1.833.589.1603. KaryForward may be able to costs of the Karyopharm Thera- help identify alternate sources of peutics product only. Patients must KayForward Patient Assistance coverage. To get started, download meet the following criteria to enroll: Program and complete an enrollment form • United States or U.S. territory Patients who are uninsured or (www.karyforward.com/pdf/karyfor- residency underinsured may be eligible to ward-enrollment-form.pdf) or call

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 63 Karyopharm Therapeutics

KaryForward at 1.877.KARY4WD • Claims management and appeals (1.877.527.9493), Monday through assistance, including providing Friday, 8:00 am to 8:00 pm ET. information about the appeals process if a denial is received. QuickStart Program This program enables providers to To get started, fax a completed initiate Karyopharm medications Enrollment Form (www. according to prescribing information karyforward.com/pdf/kary- for patients who experience a delay forward-enrollment-form.pdf) in insurance coverage. Patients may 1.833.589.1603 or call Kary- be eligible for this program if: Forward at 1.877.KARY4WD • There is an inability to verify (1.877.527.9493), Monday through insurance coverage within five Friday, 8:00 am to 8:00 pm ET. business days, and/or • Circumstances exist, including but not limited to patient safety, and/ or • A healthcare professional deter- mines the patient needs urgent access to the Karyopharm medication.

Bridge Program This program enables providers to provide eligible patients an emergency supply of a Karyopharm medication, at no cost, if they experience an unexpected disruption in therapy exceeding five business days—and if a provider determines that it is medically necessary for the patient to continue therapy without interruption.

REIMBURSEMENT ASSISTANCE KayForward® Get assistance navigating the insurance process, including: • Insurance verification, including benefits, deductibles, and copay or coinsurance • Prior authorization assistance, including identifying plan-specific requirements and providing infor- mation about the process • Coding and billing assistance, including providing information on the prescribed therapy and the respective regimen

64 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 65 Kite Pharma

Kite Pharma

Oncology-related product: Tecartus™ (brexucabtagene autoleucel) suspension for IV infusion, Yescarta® (axicabtagene ciloleucel) suspension for IV infusion

Patient and Reimbursement Assistance Website kitekonnect.com

PATIENT AND offer healthcare professionals and REIMBURSEMENT patients, contact 1.844.454.KITE ASSISTANCE (1.844.454.5483). Kite Konnect™ Through Kite Konnect, Kite Pharma makes it as easy as possible for health- care providers to connect patients to the care they need. Use Kite Konnect to assist patients throughout their treatment journey, from initial enroll- ment to logistical support and more. Kite Konnect can assist with: • Patient enrollment: Hospital portal access, cell order com- pletion, and leukapheresis scheduling • Reimbursement support: Benefits investigation, claims appeals, and support for eligible uninsured and underinsured patients • Logistics support: Connecting patients with independent founda- tions to help with transportation and housing • Ongoing commitment: Cell order tracking and continuous communication.

Yescarta is only available at author- ized treatment centers. Start by enrolling patients for therapy using the Kite Konnect Hospital Portal: https://kitekonnect.force.com/s/. To learn more about the infor- mation and support Kite Pharma

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 65 Merck

Merck

Oncology-related products: Emend® (aprepitant) capsules, Emend® (fosaprepitant dimeglumine) for injection, Intron® A (interferon alfa-2b, recombinant) for injection, Keytruda® (pembrolizumab) injection, Zolinza® (vorinostat) capsules

Vaccine: Gardasil®9 (Human Papillomavirus 9-valent Vaccine, Recombinant)

Patient and Reimbursement Assistance Websites merckaccessprogram.com merckhelps.com

PATIENT ASSISTANCE Merck Helps™ an individual may reapply as many Merck provides certain medicines times as needed. Merck Access Program and adult vaccines for free to people The Merck Access Program may be who do not have prescription drug Eligibility criteria include: able to help answer questions about or health insurance coverage and • Patient must be a United States access and support, including: who, without assistance, cannot resident and have a prescription • Benefit investigations, prior afford their Merck medicines and for a Merck product from a authorizations, and appeals vaccines. If patients need help paying healthcare provider licensed in • Insurance coverage for patients for their medicines or adult vaccines, the United States. • Co-pay assistance for eligible the Merck Patient Assistance • Patient does not have insurance patients Program may be able to help. or other coverage for their • Referral to the Merck Patient prescription medicine Assistance Program for eligibility Merck Patient Assistance • Patient cannot afford to pay for determination Program their medicine and meet certain • Reimbursement. This private and confidential income requirements. program provides certain medicines To enroll, visit merckaccessprogram. free of charge to eligible indi- Specific income requirement com/hcp/, select the prescribed medi- viduals, primarily the uninsured amounts can be found at www. cation, and use the online portal who, without assistance, could not merckhelps.com/. Select the (merckaccessportal.com/merck/) or afford needed Merck medicines. prescribed medication to see qual- complete the appropriate enrollment Individuals who don’t meet the ifications. If patients do not meet form that can be signed and submitted insurance criteria may still qualify the prescription drug coverage electronically. For hard copy forms, for the Merck Patient Assistance criteria, their income meets the print and fax the completed form to Program if they attest that they have program criteria, and there are 855.755.0518. A program representative special circumstances of financial special circumstances of financial will contact the patient and provider. and medical hardship, and their and medical hardship that apply to income meets the program criteria. their situation, you can request that For further assistance, call A single application may provide an exception be made. Patients do 855.257.3932, Monday through for up to one year of medicine free not have to be a U.S. citizen. Friday, 8:00 am to 8:00 pm ET. of charge to eligible individuals and

66 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 67 Merck

To apply, patients and providers If the patient is ineligible for this For any questions, call 855.257. must complete the Enrollment program, they may be able to get 3932, Monday through Friday, 8:am Form for the specific Merck med- help from an independent co-pay to 8:pm ET. ication. Visit merckhelps.com and assistance foundation. A represen- search for the specific medication, tative can provide information about download and complete the med- independent foundations that be ication’s Enrollment Form, mail able to provide financial support to completed forms to the address patients who do not qualify for the listed at the top. For assistance, call Merck Co-Pay Assistance Program. 800.727.5400. Each independent foundation has its own eligibility criteria and appli- Merck Co-Pay Assistance cation process. Program for Keytruda The Merck Co-pay Assistance REIMBURSEMENT Program offers assistance to eligible, ASSISTANCE privately insured patients who need help affording the out-of-pockets Merck Access Program costs for Keytruda. Once enrolled, Benefit Investigations patients pay the first $25 of their The Merck Access Program can co-pay per infusion, subject to contact insurers to obtain coverage a maximum co-pay assistance and benefits information. Visit the program benefit of $25,000 per specific Merck product site for addi- patient, per calendar year. Co-pay tional resources. assistance may be available for patients who: Prior Authorizations • Are a resident of the United States If a prior authorization is required, (including Puerto Rico) or for assistance in understanding • Have private health insurance that if a prior authorization is required, covers Keytruda under the Merck Access Program may be a medical benefit program able to help. The prior authorization • Have been prescribed Keytruda checklist and sample letter can help for an FDA-approved indication healthcare professionals understand • Meet all other criteria of the the documents and information that program. may be helpful when seeking a prior authorization. As always, providers The Merck Co-pay Assistance should check for payer-specific Program for Keytruda is not valid for requirements. patients covered under a government program, as that term is defined in the Appeals terms and conditions. The program The program may be able to help is not valid for uninsured patients. healthcare professionals understand the documents and information To enroll, visit www.merck- that may be helpful when filing an accessprogram-keytruda.com/ appeal. The appeal checklist and hcp/the-merck-copay-assis- sample appeal letter can help you to tance-program/ to enroll online or understand the documents and infor- fax the completed downloadable mation that may be helpful when form to 855.755.0518. A program filing an appeal. Please check for representative will contact the payer-specific requirements. patient and provider office.

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 67 Morphosys

Morphosys

Oncology-related product: Monjuvi®(tafasitamab-cxix) for injection

Patient and Reimbursement Assistance Website mymissionsupport.com

PATIENT ASSISTANCE receive assistance through the My Fax the completed form to MISSION Support Copay Assistance 866.870.6241 or email it to access@ My MISSION Support Program. If eligible, patients may mymissionsupport.com. The My MISSION Support program pay as little as $0 for Monjuvi, up cares about making sure eligible to $25,000 per calendar year to help MorphoSys Foundation Patient patients get the help they need to with their out-of-pocket costs. Assistance Program start treatment. Whether a patient If patients do not have insurance or is uninsured or has challenges with In order to be eligible for the Copay their copay responsibility through out-of-pocket costs through their Assistance Program, patients: their insurer presents a financial insurance plan, My MISSION • Must have commercial insurance hardship, the MorphoSys Foun- Support has a variety of programs • Must not have Medicare, dation may be able to help. Through that may be able to assist. Medicaid, or other government the MorphoSys Foundation Patient insurance Assistance Program, it is possible To enroll patients in the program, • Must meet certain guidelines set to obtain treatment at no cost. To complete the enrollment form (www. forth in the program’s terms and qualify, patients must meet certain mymissionsupport.com/enroll#fol- conditions. financial criteria. If their income low-these-easy-steps), and fax it to or insurance coverage has been 866.870.6241 or email it to access@ The Copay Assistance Program impacted by COVID-19, these mymissionsupport.com. Once the may apply to patient out-of-pocket circumstances will be considered as enrollment form is submitted, a costs incurred for Monjuvi within the program determines patients’ My MISSION Support program 180 days prior to the date patient is eligibility. specialist will work with healthcare enrolled in the program. To enroll providers to provide patient-specific in the program, please complete To enroll patients, complete support. It will also reach out to the following sections of the My the enrollment form (www. the healthcare provider within 24 MISSION Support enrollment form mymissionsupport.com/enroll#fol- hours if any additional information (www.mymissionsupport.com/ low-these-easy-steps), make sure to is needed or with directions on any enroll#follow-these-easy-steps): check the “Patient Assistance” box, next steps. • Sections 1 through 4 regarding and fax it to 866.870.6241 or email copay support and patient- and it to [email protected]. To find out more, call 855.421.6172, insurance-specific information Monday through Friday, 8:00 am to • Sections 5 and 7 regarding Independent Support 8:00 pm ET. physician information and Organizations signature Patients with coverage for Monjuvi Copay Assistance Program • Sections 9 and 10 regarding through Medicare (either through Commercially insured patients patient signature and consent. Medicare Advantage or traditional taking Monjuvi may be able to Medicare), Medicaid, or other

68 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 69 Morphosys

government-sponsored insurance mymissionsupport.com/enroll#- may be eligible for support through follow-these-easy-steps), and fax independent third-party foundations. it to 866.870.6241 or email it to My MISSION Support can provide [email protected]. To patients with contact information find out more, call 855.421.6172, for independent third-party orga- Monday through Friday, 8:00 am nizations that may be able to assist to 8:00 pm ET. your patients with the following: • Deductibles • Copays/coinsurance • Insurance premiums • Treatment-related costs, such as transportation, home care and child care

Eligibility requirements are deter- mined solely by the independent foundation and assistance avail- ability will vary by organization. For more information, call 855.421.6172, Monday through Friday, 8:00 am to 8:00 pm ET.

REIMBURSEMENT ASSISTANCE My MISSION Support The My MISSION Support program is a resource for healthcare providers for access and reim- bursement support for their patients. Its field access and reim- bursement managers can provider support access. Program specialists can help research patients-specific benefits and answer any questions related to coding and coverage for Monjuvi.

In the event of a claim denial, My MISSION Support can research the denial reason and assist healthcare providers in the preparation of an appeal submission. Once the appeal is submitted, program specialists can follow up with the insurer until a coverage determination is made.

To apply for this support, enroll patients in the program by com- pleting the enrollment form (www.

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 69 Mylan

Mylan

Oncology-related product: Fulphila® (pegfilgrastim-jmdb) injection, Ogivri® (trastuzumab-dkst) injection

Patient and Reimbursement Assistance Website mylanadvocate.com

PATIENT ASSISTANCE To contact experienced and caring or otherwise), Medicaid, Medigap, Mylan ADVOCATE patient access VA or DOD, or TriCare (regardless Mylan ADVOCATE™ specialists, call 1.833.695.2623, of whether a specific prescription Mylan ADVOCATE is available Monday through Friday, 9:00 am to is covered by such government to assist with questions about 8:00 pm ET. Patient support services program); if the patient is Medicare billing and coding and patient and resources are available 24 hours eligible and enrolled in an employ- access to Mylan medicines. Mylan a day, 7 days a week, via the Mylan er-sponsored health plan or ADVOCATE can help with the ADVOCATE portal at https://www. prescription benefit program for following: mylanadvocateportal.com/myl/ retirees; or if the patient’s insurance • Commercially insured patients login#/. plan is paying the entire cost of this may be able to access their prescription. prescribe Mylan medicines at a Mylan ADVOCATE Co-Pay reduced copay. Assistance Program REIMBURSEMENT • Patients without insurance Commercially insured patients may ASSISTANCE coverage for their prescription who be able to access Mylan medicines cannot afford their medication may for as little as a $0 co-pay. There Mylan ADVOCATE™ be able to receive their medication are no income restrictions for this A team of dedicated patient access free of charge. Eligibility require- program. The Mylan ADVOCATE specialists is available to answer calls ments apply based on residency, Co-Pay Assistance Program is open and address concerns or questions income, and other factors. to both new and existing eligible regarding: Contact Mylan ADVOCATE for patients who are residents of the • Billing and coding. Mylan can more information. United States or Puerto Rico and provide information about appli- • Mylan ADVOCATE can help who have commercial prescription cable coding. identify other resources, such drug insurance. For Fulphia, the • Insurance coverage verification. as state programs or third-party program is subject to a maximum of Mylan can help check patient charitable foundations, that may $10,000 per 12-month period. insurance plan enrollment status. be able to assist patients. • Benefit investigation. Mylan This co-pay assistance program is can assist in researching To enroll a patient, use the Myland not valid for uninsured patients patient-specific insurance Advocate Provider Portal (https:// or commercially insured patients coverage, coding, and billing www.mylanadvocateportal.com/myl/ without coverage for their medi- requirements; verify patient cost- login#/) online or download and fax cation; patients who are covered sharing requirements including the completed Mylan ADVOCATE in whole or in part by any state deductible, copay, coinsurance, Patient Enrollment Form (https:// or federally funded healthcare out-of-pocket maximum, and www.fulphila.com/-/media/ful- program, including, but not limited amounts met to date; determine philacom/pdf/patient_enrollment. to, any state pharmaceutical assis- payer access requirements (e.g. pdf?la=en) to 833.247.2756. tance program, Medicare (Part D specialty pharmacy, in-office

70 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 71 Mylan

dispensing, etc.); and prepare a summary of benefits that Patient Assistance Checklist for Uninsured Patients documents all findings. • Prior authorization/reauthori- 3 I have received the chemotherapy order written by the physician? zation assistance and tracking. 3 I have met with the patient to assess his or her ability to pay for Mylan can assist in checking prior treatment? authorization requirements, sub- 3 Based on this meeting, is the patient able to pay out-of-pocket for drug(s)? mission details, and track status, q YES q NO as well as provide offices with If no, list drug(s) below and continue on with checklist. payer-specific forms. • Coverage and claim. Mylan can 3 Is a replacement drug program available? q YES q NO verify appeal requirements and If yes, identify drug and program: track the status and resolution of appeals. 3 Does the patient qualify for this program? q YES q NO If no, state reason(s) why: For more information call Mylan ADVOCATE at 1.833.695.2623, 3 If yes, I have completed all the necessary forms and paperwork for the Monday through Friday, 9:00 am drug replacement program. q YES q NO to 8:00 pm ET, or go to mylan If no, state reasons why: advocate.com. 3 Does the patient need drug(s) that are not available through a drug replacement program? q YES q NO If yes, identify which drugs:

3 Is Foundation funding assistance available for any of these drug(s)? q YES q NO If yes, identify Foundation(s) and drug(s):

3 I have completed all the necessary forms and paperwork for these Foundation funding program(s). q YES q NO If no, state reasons why:

3 Does the patient qualify for charity care within from my clinic, cancer center, hospital, or healthcare system? q YES q NO If yes, identify program:

3 I have completed all the forms and paperwork necessary to apply for this charity care. q YES q NO If no, state reasons why:

3 Is there a balance or money owed related to treatment? q YES q NO If yes, identify balance:

3 If yes, I have worked with the patient and family to create a payment plan for the balance of his or her treatment costs. q YES q NO

Source. ACCC Financial Advocacy Network. accc-cancer.org/FAN

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 71 Novartis

Novartis Pharmaceuticals Corporation

Oncology-related products: Adakveo® (crizanlizumab-tmca) for IV infusion, Afinitor® (everolimus) tablets, Exjade® (deferasirox) tablets for oral suspension, Femara® (letrozole) tablets, Gleevec® (imatinib mesylate) tablets, Jadenu® (deferasirox) tablets, Kisqali® (ribociclib) tablets, Kymriah® (tisagenlecleucel) suspension for IV infusion, Mekinist® (trametinib) tablets, Piqray® (alpelisib) tablets, Promacta® (eltrombopag) tablets, Rydapt® (midostaurin) capsules, Sandostatin® (octreotide acetate) injection, Sandostatin® LAR Depot (octreotide acetate) for injectable suspension, Tabrecta™ (capmatinib) tablets, Tafinlar® (dabrafenib) capsules, Tasigna® (nilotinib) capsules, Tykerb® (lapa- tinib) tablets, Votrient® (pazopanib) tablets, Zometa® (zoledronic acid) for injection, Zykadia® (ceritinib) tablets

Patient and Reimbursement Assistance Websites hcp.novartis.com/access patient.novartisoncology.com/financial-assistance/

PATIENT ASSISTANCE • Insurance benefits verification, charge patients a fee to assist them including information on prior in completing applications for its Patient Assistance Now authorizations and denial appeals program. To be eligible patients Oncology (PANO) • A combination of PANO case must: PANO is the preferred first stop for managers and/or field reim- • Be a U.S. resident access to Novartis Oncology Patient bursement managers are available • Provide proof of income that Support programs. Through one- to help, depending on the case meets financial eligibility on-one guidance with a dedicated complexity of a patient's case. requirements case manager, patients will discover • Have limited or no prescription which Novartis Oncology Patient To learn more about how PANO can coverage. (Exceptions exist for Support programs they are eligible help, call 1.800.282.7630. individuals with limited pre- to receive and may also be referred scription coverage.) to other services. The Novartis Patient Assistance Foundation There are two ways to enroll in the Support for patients include: This foundation may help provide program: • Information about financial assis- access to Novartis medicines to • Fill out the PANO Service Request tance that may be available patients experiencing financial Form online by visiting • Patient support counselors who hardship and/or have no third- patient.novartisoncology.com/ are able to provide information in party insurance coverage for their financial-assistance/PANO/. more than 160 languages medicines. Please be advised that • Download and complete the • Patient navigators who provide access to the medicines distributed PANO Service Request Form one-on-one support specific to a through the Novartis Patient Assis- (www.patient.novartisoncology. patient’s Novartis medication tance Foundation, Inc., is free com/financial-assistance/PANO/), • Dedicated case managers with private of charge to all eligible patients. and fax the completed form to extensions whom you can contact Novartis is not affiliated with any 1.888.891.4924. directly for updates on patients individual or organization that may

72 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 73 Novartis

Providers should submit their part The organizations and websites listed separately. Once PANO gets both are independently operated and not parts, a case manager will review the managed by Novartis Pharmaceuticals patient’s insurance information to Corporation. Novartis assumes no determine if they are eligible. responsibility for any information they may provide. For more information, please call 1.800.282.7630, Monday through Kymriah Cares® Friday, 9:00 am to 8:00 pm ET. Whether patients and providers have questions about Kymriah, or Universal Co-Pay Card insurance coverage, Kymriah Cares The Novartis Oncology Universal can help. The program can provide Co-pay Program is available for assistance with treatment center almost all Novartis Oncology support, patient support, and coor- medicines. dination of care support.

Eligible, privately insured patients To learn more, call 1.844. 4KYMRIAH may pay $25 per month and (1.844.459.6742), 8:00 am to 8:00 Novarits will pay the remaining pm ET. co-pay, up to $15,000 per calendar year, per product. The Novartis REIMBURSEMENT Oncology Universal Co-pay Program ASSISTANCE includes the co-pay card, payment card, or rebate with a combined Patient Assistance Now annual limit of $15,000. Patient Oncology (PANO) is responsible for any costs once PANO is the preferred first stop for the limit is reached in a calendar access to Novartis Oncology Patient year. This program is not available Support programs. Through one- for patients who are enrolled on-one guidance with a dedicated in Medicare, Medicaid, or any case manager, patients will discover other federal or state health care which Novartis Oncology Patient program. Novartis reserves the Support programs they are eligible right to rescind, revoke, or amend to receive and may also be referred this program without notice. Find to other services. Support for out if a patient is eligible to enroll patients includes: in the program by visiting Copay. • Insurance benefits verification NovartisOncology.com or by calling • Information on prior 1.877.577.7756. authorization • Information on denial appeals. Independent Charitable Foundations Get started today by submitting If patients have government the PANO Service Request Form insurance, there may be financial online (https://www.hcp.novartis. assistance options available. To see com/access/). To learn more call a full list of third-party resources 1.800.282.7630, Monday through that may be able to help patients Friday, 9:00 am to 8:00 pm ET. get financial assistance visitwww. patient.novartisoncology.com/ financial-assistance/government- insurance/.

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 73 Pfizer

Pfizer, Inc.

Oncology-related products: Aromasin® (exemestane) tablets, Besponsa® (inotuzumab ozogamicin) injection for IV infusion, Bosulif® (bosutinib) tablets, Camptosar® (irinotecan hydrochloride) injection, Daurismo™ (glasdegib) tablets, Ellence® (epirubicin hydrochloride) injection, Ibrance® (palbociclib) capsules, Idamycin® (idarubicin hydrochloride) injection, Inlyta® (axitinib) tablets, Lorbrena® (lorlatinib) tablets, Mylotarg™ (gemtuzumab ozogamicin) for injection, Nivestym® (filgrastim-aafi) injection, Ruxience™ (rituximab-pvvr) injection, Sutent® (sunitinib malate) capsules, Talzenna® (talazoparib) capsules, Torisel® (temsirolimus) injection, Trazimera™ (trastuzumab-qyyp) injection, Vizimpro® (dacomitinib) tablets, Xalkori® (crizotinib) capsules, Zinecard® (dexrazoxane) for injection, Zirabev™ (bevacizumab-bvzr) injection

Patient and Reimbursement Assistance Websites pfizeroncologytogether.com pfizerrxpathways.com/

PATIENT ASSISTANCE together.com/enroll) and fax the state or federally funded insurance completed form to 1.877.736.6506. program, including but not limited Pfizer Oncology For questions, please call 1.877.744. to Medicare, Medicaid, TriCare, Together™ 5675, Monday through Friday, 8:00 Veterans Affairs health care, a At Pfizer Oncology Together, patient am to 8:00 pm ET. Visit pfize- state prescription drug assistance support is at the core of everything roncologytogether.com for more program, or the Government Health it does. From helping to identify information. Insurance Plan available in Puerto financial assistance options to Rico. For oral products, the offer connecting patients to resources for Pfizer Oncology Together will be accepted only at participating emotional support, patients’ needs Co-Pay Savings Card pharmacies. This offer is not health are the priority. Eligible, commercially insured insurance. Pfizer reserves the right to patients may pay as little as $0 per rescind, revoke, or amend this offer Pfizer Oncology Together can month for the oral medications without notice. For more infor- provide access and reimbursement or per treatment for injectable mation, call 1.877.744.5675 or visit support, as well as help identifying medications for select Pfizer medi- www.pfizeroncologytogether.com/. financial assistance options, so cations through the co-pay savings patients can get their prescribed programs. For oral products, Pfizer Patient Assistance Program Pfizer Oncology medicines. patients may receive up to $25,000 Eligible patients may receive up per product in savings annually. For to a 90-day supply of Pfizer medi- To enroll patients, providers can use injectable products, the maximum cation for free, while applying for the Provider Portal (https://www. annual patient savings range from Medicaid. If patients do not qualify pfizeroncologytogether-portal.com/) $10,000 to $25,000. for Medicaid, they may be able or download the Patient Support to get a one-year supply of medi- Program & Patient Assistance Patients are not eligible for these cation for free through the Pfizer Enrollment Form (pfizeroncology- programs if they are enrolled in a Patient Assistance Program, or at a

74 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 75 Pfizer

savings through the Pfizer savings Availability of support from the • Online support: Log in to the Program. Patients must meet eligi- foundations is determined solely by provider portal (www.pfizeron- bility requirements and reapply as the foundations. cologytogether-portal.com/) to needed. complete and submit an online Pfizer RxPathways® enrollment form, track the status To qualify for free medicine, patients Pfizer RxPathways connects eligible of patient cases, and for secure must meet certain financial require- patients to a range of assistance messaging with Pfizer Oncology ments, as well as meet the criteria programs that offer insurance Together. below: support, co-pay help, and medicines • Have a valid prescription for the for free or at a savings. Visit www. Pfizer Oncology field reimbursement Pfizer medication for which they pfizerrxpathways.com/ to search by managers are trained to help are seeking assistance the prescribed medication's name address specific access issues in • Reside in the U.S. or a U.S. and see which available programs person or over the phone. They territory are right for patients. can help educate provider’s staff on • Have no prescription coverage or Pfizer’s access and reimbursement not enough coverage to pay for REIMBURSEMENT resources and help address chal- their Pfizer medicine ASSISTANCE lenging or urgent Pfizer oncology • Be treated by a healthcare patient cases that have been sent provider licensed in the U.S. or a Pfizer Oncology to Pfizer Oncology Together. To U.S. territory. Together™ get in contact with the field reim- If patients need access or reim- bursement manager in your area, The Pfizer Patient Assistance bursement support for their call 1.877.744.5675. Program is a joint program of Pfizer prescribed Pfizer oncology medi- Inc. and the Pfizer Patient Assistance cations, the following support is For questions, call 877.744.5675. Foundation. The Pfizer Patient Assis- available: Monday through Friday, 8:00 am to tance Foundation is a separate legal • Benefits verification: Pfizer 8:00 pm ET. entity from Pfizer Inc. with distinct can conduct a benefits verification legal restrictions. to determine patients' health insurance coverage and If a patient is accepted into the out-of-pocket costs. Pfizer Patient Assistance Program, • Prior authorization: Pfizer will Pfizer will inform the healthcare coordinate with patients’ insurer professional by fax and phone and to determine the prior authori- the patient by phone and letter. zation requirements, where and Uninsured patients may receive free how to submit requests, and medication for up to one calendar typical turnaround times. Pfizer year, while underinsured patients will also follow up with the are enrolled through the end of the insurer on behalf of patients and calendar year. For more information, track the progress until a final call 1.877.744.5675 or visit outcome is determined. www.pfizeroncologytogether.com/. • Appeals assistance: If patients' claims are denied, Pfizer can help Support from Independent healthcare professionals under- Charitable Organizations stand the payer requirements as Pfizer will assist patients with you prepare an appeal submission. searching for financial support that After the provider's office submits may be available from independent an appeal, Pfizer will follow charitable foundations. These up with the payer to track its foundations exist independently of progress until a final outcome is Pfizer and have their own eligibility determined. criteria and application processes.

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 75 Pharmacyclics

Pharmacyclics, LLC

Oncology-related product: Imbruvica® (ibrutinib) capsules

Patient and Reimbursement Assistance Website imbruvicahcp.com/you-i-support/access-support/

PATIENT ASSISTANCE own rules for eligibility. YOU&i has tingency or other obligation. no control over these independent YOU&i™ Support Program charitable organizations. To enroll, fax the complete YOU&i Instant Savings Program Patient Enrollment Form (https:// Eligible patients with commercial Dose Exchange Program imbruvicahcp.com/you-i-support- insurance pay no more than $10 This program is available to rapidly program-enrollment-form.pdf) to per prescription for Imbruvica with facilitate a dose reduction for 800.752.5896. a maximum limit of $24,600 per patients taking the single-tablet calender year. This program applies formulation should their prescriber REIMBURSEMENT to commercial insurance co-pay, decide to adjust their dose before ASSISTANCE deductible, and coinsurance medi- they have finished their current pack cation costs. The program cannot be of Imbruvica. YOU&i™ Support Program used with any other federally-funded The YOU&i Support Program is prescription insurance plan which To enroll, download a Dose a personalized program that helps includes Medicare Part D, Medicare Exchange Prescription and Enroll- patients learn about access to Advantage Plan, Medicaid, TriCare, ment Form (https://imbruvicahcp. Imbruvica, find affordability support or any other federal or state health com/cll/support-and-resources/dose- options, and sign up for information care plan, including pharmaceutical exchange-program/#) and submit and resources to support them along assistance programs. To enroll in the completed form with prescriber’s their treatment journey. Patients will the program, visit https://sservices. signature to the YOU&i Support learn about access through: trialcard.comCoupon/YouAndI/. Program by fax to 1.800.752.5896. • Rapid benefits investigation For more information, call • Information on the prior 1.877.877.3536, Monday through Temporary Access authorization process Friday, 8:00 am to 8:00 pm ET. The YOU&i Support Program • Navigating the exception and can provide access to Imbruvica appeals process. Independent Charitable for new patients who are experi- Organizations encing insurance coverage decision To learn more about the YOU&i For patients with federally funded delays. Eligible patients who have Support Program, call 1.877.877. Medicare, Medicaid, or commercial been prescribed Imbruvica for an 3536, Monday through Friday, insurance, financial assistance may FDA-approved indication and 8:00 am to 8:00 pm ET, Saturday, potentially be available from inde- who are experiencing an insurance 8:00 am to 5:00 pm ET, or visit pendent charitable organizations. coverage decision delay greater than its website at imbruvicahcp.com/ Contact information for such inde- 5 business days can receive a free you-i-support/access-support. pendent charitable organizations is 30-day supply of Imbruvica. The available upon request. Independent free product is offered to eligible charitable organizations have their patients without any purchase con-

76 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 77 Pharmacyclics

Nurse Call Support & Other Clinical Resources The You&i Support Program has nurses who are available to support patients with: • A resource-filled Starter Kit designed for new patients con- taining disease information, tips on building a medication routine, adherence tools, and more • Nurse call support personalized to patients’ preferences for frequency and method of contact • Referrals of patients seeking medical advice back to their healthcare providers.

Call 1.877.877.3536 for more infor- mation about the You&i Support Program.

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 77 Regeneron and Sanofi

Regeneron Pharmaceuticals, Inc., and Sanofi Genzyme

Oncology-related products: Libtayo® (cemiplimab-rwlc) injection

Patient and Reimbursement Assistance Website libtayohcp.com/accessinglibtayo

PATIENT ASSISTANCE service associated with Libtayo. the provider portal (https:// General non–product-specific copays, www.libtayosurroundportal. LIBTAYO Surround® coinsurance, or insurance deductibles com/libtayoprovider/s/ LIBTAYO Surround helps eligible are not covered. Additional program login/?ec=302&startURL=%- patients access Libtayo and navigate conditions apply. See libtayohcp. 2Flibtayoprovider%2Fs%2F) the health insurance process. Visit com/ for more information. • Or call Libtayo Surround its website (libtayohcp.com) to at 1.877.LIBTAYO download additional tools and The program is not valid for (1.877.542.8296). helpful resources about Libtayo cash-paying customers. To be eligible: Surround offerings. For more • Patients must be insured by a Patient Assistance Program information call, 1.877.LIBTAYO commercial health plan that Eligible patients who meet income (1.877.542.8296), Option 1, requires a copayment, coin- requirements and are uninsured, Monday through Friday, 8:00 am to surance, and/or deductible amount lack coverage for Libtayo, or have 8:00 pm ET. for Libtayo. Medicare Part B with no supple- • Patients must be residents of the mental insurance coverage may Commercial Copay Program United States or its territories or receive Libtayo at no cost. Patients Eligible patients with commercial possessions. without insurance coverage or insurance may pay as little as $0 • Patients must be at least 18 years patients with inadequate insurance for Libtayo, which includes any of age. coverage who need assistance with product-specific copay, coinsurance, • Patients must be prescribed out-of-pocket medication costs may and insurance deductibles—up to Libtayo for an FDA-approved be eligible for alternate funding $25,000 in assistance per year. There indication. sources for Libtayo. Patients must is no income requirement to qualify have an annual gross household for this program. There are three ways to enroll income that does not exceed the patients in the copay program: greater of $100,000 or 500 percent This program is not valid for pre- • Download the LIBTAYO of the federal poverty level. Enroll scriptions covered by or submitted Surround Enrollment Form (www. patients via the provider portal or for reimbursement under Medicare, libtayohcp.com/accessinglibtayo/ Libtayo Surround enrollment form Medicaid, Veterans Affairs/ patientaccessandreimbursement- (www.libtayohcp.com/accessing Department of Defense, TriCare, or support), check the box in section libtayo/patientaccessandreimburse- similar federal or state programs. 1 marked "Copay Assistance," mentsupport). This program is not a debit card and fax the completed form to program and does not cover or 1.833.853.8362. provide support for supplies, pro- • Physician offices can also cedures, or any physician-related apply on patients' behalf via

78 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 79 Regeneron and Sanofi

For more information, call 1.877. Upon enrollment, a reimbursement LIBTAYO (1.877.542.8296), Option specialist can provide the following 1, Monday through Friday, 8:00 am assistance: to 8:00 pm ET. • Benefits investigation • Prior authorization support Identification of Alternate to review and explain payer Sources of Funding requirements Patients without insurance coverage • Appeal assistance when prior or patients with inadequate authorizations are denied insurance coverage who need assis- • Claims assistance to address tance with out-of-pocket medication questions as healthcare providers costs may be eligible for alternate prepare claims and to review the funding sources for Libtayo. status of claims with the patient’s health insurer. For more information, call LIBTAYO Surround at 1.877. For more information, call 1.877. LIBTAYO (1.877.542.8296). LIBTAYO (1.877.542.8296), Option 1, Monday through Friday, 8:00 am Nurse Support to 8:00 pm ET. Patients can contact a LIBTAYO Surround nurse advocate 24/7 to receive the following additional support throughout their treatment journey: • Information on patient advocacy groups and local support organi- zations, transportation services, and travel and lodging • General patient education • Appointment reminders.

REIMBURSEMENT ASSISTANCE LIBTAYO Surround® LIBTAYO Surround provides access and reimbursement support to help patients receive their medication as quickly as possible. Upon receipt of a LIBTAYO Surround enrollment form, a LIBTAYO Surround reim- bursement specialist may be able to provide several types of assistance. To enroll, download the LIBTAYO Surround Enrollment Form (www. libtayohcp.com/accessinglibtayo/ patientaccessandreimbursement- support), make sure each field is complete and accurate, sign the form, and fax the completed form to 1.833.853.8362.

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 79 Sandoz

Sandoz

Oncology-related products: Zarxio® (filgrastim-sndz) subcutaneous or intravenous injection, Ziextenzo®(pegfilgrastim-bmez) injection

Patient and Reimbursement Assistance Websites zarxio.com/resources/patient-support/ ziextenzo.com/hcp/patient-services.html

PATIENT ASSISTANCE Monday through Friday, 8:00 am reimburse the patient for the entire to 8:00 pm ET. cost of their prescription drugs, Sandoz One Source® or where prohibited by law. The Sandoz One Source provides com- Commercial Co-Pay Program program may apply to out-of-pocket prehensive patient support services The Sandoz One Source Commercial expenses that occurred within designed to help simplify and Co-Pay Program supports eligible, 120 days prior to the date of the support patient access. Available commercially insured patients with enrollment. services include: their out-of-pocket costs for Zarxio • Benefit investigations or Ziextenzo. There are no income There are three ways to enroll: • Prior authorization and appeals requirements. The virtual co-pay 1. Instruct patients to enroll in support card ensures that patients have co-pay online at prescribed medi- • In-home injection training immediate access to their benefits. cation’s website • Commercial co-pay program 2. Submit an online Sandoz • Independent foundation Patients may pay $0 out-of-pocket One Source enrollment form information for the first dose or cycle and for (https://qv.trialcard.com/ • Patient assistance program subsequent doses or cycles up to onesource-hub#/app/layout/home) • Billing and coding support a maximum benefit of $10,000 3. Download and fax the Sandoz • General payer policy information. annually. Patients’ prescription must One Source enrollment form be for an approved indication. This (https://ziextenzo.com/pdf To enroll, patients and providers can program is for insured patients only; /ZIEXTENZO-Sandoz-One-Source- apply for support using the savings cash-paying or uninsured patients Enrollment-Form.pdf) to portal at https://qv.trialcard.com/ are not eligible. 1.844.726.3695. onesource-hub#/app/layout/home. You can also download and complete Patients are not eligible if prescription Product Replacement Program the enrollment form (ziextenzo.com/ for Ziextenzo or Zarxio is paid, in As a supplement to the Sandoz pdf/ZIEXTENZO-Sandoz-One- whole or in part, by any state or returns policy, Sandoz Once Source Source-Enrollment-Form.pdf) federally funded programs, including offers a simple product replacement and fax the completed form, but not limited to Medicare (including process for spoiled Zarxio or including selected services, to Part D, even in the coverage gap) Ziextenzo products under the 1.844.726.3695. or Medicaid, Medigap, VA, DOD, following circumstances: or TriCare, or private indemnity • Product was mishandled, dropped, For more information, call 1.844. plans that do not cover prescription or broken SANDOZ1 (1.844.726.3691), drugs, or HMO insurance plans that • There was an admixture error

80 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 81 Sandoz

• Product was inappropriately stored or refrigerated, or was frozen • Product was reconstituted but not administered due to an unforeseen reason.

Contact Sandoz One Source at 1.844.SANDOZ1 (1.844.726.3691) to request a replacement product.

REIMBURSEMENT ASSISTANCE Sandoz One Source® Sandoz One Source provides services designed to help simplify and support patient access. Available services include: • Benefit investigations • Prior authorization support • Appeals support • Billing and coding support • General payer policy information.

To enroll, patients and providers can apply for support using the savings portal https://qv.trialcard.com/one- source-hub#/app/layout/home. You can also download and complete the enrollment form (ziextenzo.com/pdf/ ZIEXTENZO-Sandoz-One-Source- Enrollment-Form.pdf) and fax the completed form to 1.844.726.3695.

For more reimbursement infor- mation, call 1.844.SANDOZ1 (1.844.726.3691), Monday through Friday, 8:00 am to 8:00 pm ET.

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 81 Sanofi Genzyme

Sanofi Genzyme

Oncology-related products: Elitek® (resburicase) IV infusion, Jevtana® (cabazitaxel) injection, Sarclisa® (isatuximab-irfc) injection for IV use

Patient and Reimbursement Assistance Website SanofiCareASSIST.com/hcp

PATIENT ASSISTANCE • Have commercial or private through the online portal (Care insurance, which includes state or ASSISTProviderPortal.com). CareASSIST® federal employee plans and health CareASSIST helps eligible patients insurance exchanges CareASSIST Patient Assistance with access and support for the • Be residents of the United States Program treatment they've been prescribed, or its territories or possessions. For patients who meet program including: eligibility requirements for financial • Access and reimbursement There is no income requirement to assistance through CareASSIST, • Financial assistance qualify for this program. Eligible medication can be provided at no • Resource support. patients will remain enrolled in the cost through the CareASSIST Patient program for 12 months dating from Assistance Program. In order to To enroll, download the Enrollment the time of approval. Patients will be eligible, patients must meet the Application (sanoficareassist.com/-/ be evaluated for continued eligibility following requirements: media/EMS/Conditions/Oncology/ on an annual basis. As appropriate, • Patient must be a resident of the Brands/sanoficareassist/DTC/pdf/ their enrollment will be renewed. United States or its territories or SAUS_ONC_19_03_1902_3_ Other conditions apply. possessions and be under the care of PSP_Enroll_Form_Copay_INTER- a licensed healthcare provider autho- ACTIVE.pdf?la=en-US) and fax the To get started, download and print rized to prescribe, dispense, and completed form to 1.855.411.9689. a CareASSIST application (sano- administer medication in the U.S. Healthcare professionals can also ficareassist.com/-/media/EMS/ • Patient must have no insurance enroll patients through the online Conditions/Oncology/Brands/ coverage or lack coverage for the portal (CareASSISTProvider- sanoficareassist/DTC/pdf/SAUS_ prescribed therapy Portal.com). For any questions or ONC_19_03_1902_3_PSP_Enroll_ • Patients with Medicare Part B assistance, call 1.833.WE+CARE Form_Copay_INTERACTIVE. with no supplemental insurance (1.833.930.2273), Monday through pdf?la=en-US). Make sure the coverage may be eligible Friday, 9:00 am to 8:00 pm ET. “CareASSIST Copay Program” • Patient must have an annual box in Section 1 is checked and household income that does not CareASSIST Copay Program fax the completed application exceed the greater of $100,000 or Eligible patients with commercial to 1.855.411.9689. The appli- 500 percent of the current Federal insurance may pay as little as $0 for cation process can also be started Poverty Level. their Sanofi Genzyme medicines, by calling 1.833.WE+CARE including any product-specific copay, (1.833.930.2273) where a CareASSIST Approved patients may remain coinsurance, and insurance deduct- Patient access specialist will assist enrolled for up to 12 months. If ibles—up­ to $25,000 in assistance with the next steps, or healthcare longer assistance is required, they per year. To be eligible, patients must: professionals can enroll patients may reapply on a yearly basis. To

82 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 83 Sanofi Genzyme

get started, download and print REIMBURSEMENT a CareASSIST application (sano- ASSISTANCE ficareassist.com/-/media/EMS/ Conditions/Oncology/Brands/ CareASSIST® sanoficareassist/DTC/pdf/SAUS_ CareASSIST Patient Access Spe- ONC_19_03_1902_3_PSP_Enroll_ cialists can help evaluate patients’ Form_Copay_INTERACTIVE. insurance coverage and identify pdf?la=en-US). Make sure the options, including the following “CareASSIST Patient Assistance services: Program" box in Section 1 is • Insurance verification, including checked and fax the completed benefits, deductibles, and copay application to 1.855.411.9689. or coinsurance: Full benefit verifi- The application process can also be cation is specific to the prescribed started by calling 1.833.WE+CARE therapy from Sanofi Genzyme and (1.833.930.2273) where a Care- the patient’s insurance plan ASSIST Patient access specialist • Prior authorization assistance: will assist with the next steps, or Patient Access Specialists identify healthcare professionals can enroll plan-specific requirements and can patients through the online portal provide information about the (CareASSISTProviderPortal.com). process • Claims management and appeals Alternate Sources of Coverage assistance: Patient Access Spe- CareASSIST may be able to identify cialists can provide information sources of coverage for patients who about the appeals process if a are uninsured or lack coverage, or denial is received. who need assistance with their out- of-pocket medication costs. To learn more, call 1.833.WE+CARE (1.833.930.2273), Monday through Through CareASSIST, a patient Friday, 9:00 am to 8:00 pm ET. access specialist may be able to: • Identify potential alternate coverage programs and explain their benefits • Answer questions about the appli- cation process for such programs • Provide the contact information for such programs

Possible alternate coverage sources, include Medicaid, state health exchanges, state pharmaceutical assistance programs, and inde- pendent charitable foundations.

For more information, call 1.833. WE+CARE (1.833.930.2273).

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 83 Seattle Genetics

Seattle Genetics

Oncology-related product: Adcetris® (brentuximab vedotin) for injection, Tukysa® (tucatinib) tablets

Patient and Reimbursement Assistance Website seagensecure.com

PATIENT ASSISTANCE Commercial Out-of-Pocket Quick Start Program Assistance The Quick Start Program provides SeaGen Secure® For insured patients who cannot afford a 15-day supply of product at no SeaGen Secure is a comprehensive their coinsurance or out-of-pocket cost to patients who experience an assistance program for patients who costs, assistance is available. To be insurance-related access delay. have been prescribed Adcetris or eligible, patients must: Tukysa. For more information about • Have commercial health insurance Additional Assistance SeaGen Secure, call 855.4SECURE with coverage for Adcetris or Information (855.473.2873), Monday through Tukysa SeaGen Secure can refer patients to Friday, 8:00 am to 8:00 pm ET. • Be receiving the prescribed medi- independent outside organizations cation for an on-label indication for additional logistics support, psy- Patient Assistance Program • Be a permanent U.S. resident chosocial care, and financial needs. For patients with no insurance, the • If prescribed Adcetris, meet Patient Assistance Program provides income requirements. REIMBURSEMENT product at no cost. It provides the ASSISTANCE oral oncology therapy for up to one Patients will need to provide income year to patients who meet program and residency documentation if pre- SeaGen Secure® eligibility requirements. The pre- scribed Adcetris. If eligible, SeaGen Before patients start treatment, scribed medication must be ordered Secure will send assistance to the SeaGen Secure case managers are for each dispense. To be eligible, provider on behalf of the patient. available to answer reimbursement patients must: The patient may receive assistance questions about Seattle Genetics • Meet income requirements for the duration of their therapy if therapies, including: • Be a permanent United States they remain eligible. There are some • Coverage as determined by a resident program limits/caps. benefits investigation • Provide income and residency • Prior authorization assistance documentation. To enroll, complete the medica- • Appeals assistance. tion-specific Healthcare Provider To enroll, complete the medica- Request Form and Patient Autho- Benefits Investigation tion-specific Healthcare Provider rization Form (seagensecure.com) Enroll patients in SeaGen Secure Request Form and Patient Autho- and fax the completed forms to to start the benefits investigation rization Form (seagensecure.com) 855.557.2480 or e-mail it to CaseM- process. SeaGen Secure will fax and fax the completed forms to [email protected]. To enroll providers a summary of benefits 855.557.2480 or e-mail it to CaseM- over the phone, call 855.4SECURE within two business days of [email protected]. To enroll (855.473.2873). receiving the completed request, and over the phone, call 855.4SECURE the provider will receive a call to (855.473.2873). discuss the results and next steps.

84 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 85 Seattle Genetics

Claims Assistance SeaGen Secure case managers can help providers track claims to ensure they are being processed and paid on time. Case managers can also assist with denied or underpaid claims.

To speak to a case manager, call 855.4SECURE (855.473.2873), Monday through Friday, 8:00 am to 8:00 pm ET.

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 85 Sun Oncology

Sun Pharmaceuticals Industries, Inc.

Oncology-related products: Odomzo® (sonidegib) capsules, Yonsa® (abiraterone acetate) tablets

Patient and Reimbursement Assistance Websites yonsarx.com odomzo.com/hcp/financial-assistance

PATIENT ASSISTANCE benefit per fill and a maximum • Research eligibility for the patient program benefit of up to $12,000 assistance program. Yonsa Support™ per calendar year. This offer is not Yonsa Support is a comprehensive valid for patients without com- For more information or any resource for patients taking Yonsa. mercial inurance coverage or if questions, call the program Support programs are subject to prescription is paid for by any state at 1.844.5.ODOMZO terms and conditions and patients or federally funded health care (1.844.563.6696), Monday through must be enrolled in Yonsa Support program, including but no limited Friday, 8:00 am to 8:00 pm ET. to qualify. These services include: to Medicare, Medicaid, VA, DOD, • Co-Pay Program: Eligible, com- or TriCare. The program is available Co-pay Program mercially insured patients access to United States, Guam, Virgin Eligible, commercially insured patients their Yonsa prescriptions. Islands, or Puerto Rico residents 18 years or older may pay as little • Patient Assistance Program: only. There may be additional terms as $10 a month for an Odomzo Patients who are underinsured and conditions that also apply. prescription, subject to a $15,000 or uninsured may be eligible to Visit activatethecard.com/7702/# to maximum annual program benefit. receive free medication. To get enroll patients and learn additional After the program maximum, patients patients started with the program, information. will be responsible for the difference. complete and submit program This offer is valid only for patients application. Odomzo Support™ with commercial insurance and who Odomzo Support streamlines have a valid prescription. This offer is To apply for the Patient Assistance access to Odomzo for patients and not valid under Medicare, Medicaid, Program, complete a patient enroll- providers. Once the application is or any other federal or state ment form (www.yonsarx.com/) and submitted, a program coordinator program, for cash-paying patients, fax it to 1.877.872.6575. will then evaluate if patients are where the product is not covered by eligible for financial assistance. patient’s commercial insurance, or For any questions about the Patient (Qualified patients must meet certain where a plan reimburses patients for Assistance Program application, call medical and financial criteria.) Once the entire cost of prescription drug. 1.855.44YONSA (1.855.449.6672) a benefits investigation iscomplete, One card per patient, not trans- Monday through Friday, 8:00 am to Odomzo Support will: ferable, and cannot be combined 8:00 pm ET. • Follow up with healthcare pro- with any other offer. Additional fessionals to make sure the prior terms and conditions may apply. Co-pay Program authorization is submitted and Eligible, commercially insured approved Patients can activate this card patients may pay as little as $10 • Process the outcome of the by calling 1.877.ODOMZO.1 for each fill of a Yonsa, subject benefits investigation and evaluate (1.877.636.6961) or by visiting to a $5,000 maximum program patients' eligibility www.activatethecard.com/7436.

86 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 87 Sun Oncology

Patient Assistance Program Prior Authorization Assistance Odomzo Support will initiate a Sun Pharma and CoverMyMeds benefits investigation of patients’ are working together to expedite insurance coverage for Odomzo. If the prior authorization process to applicable, the program will research help patients receive their Odomzo eligibility for the patient assistance therapy as prescribed. For more program for non-insured, functionally information, contact CoverMyMeds uninsured, and underinsured patients. at 1.866.452.5017. Income documentation is required. Available to U.S., Guam, Virgin Islands, or Puerto Rico residents only.

To enroll, prescribers are required to complete the enrollment form (www. odomzo.com/savings) in its entirety with the patient, as well as sign and fax the form and any supporting documents to Odomzo Support at 1.877.872.6575.

REIMBURSEMENT ASSISTANCE Yonsa Support™ Yonsa Support is a comprehensive resource for patients taking Yonsa. Sun Pharma and CoverMyMeds are working together to expedite the prior authorization process. For more information, contact Cover- MyMeds at 1.866.452.5017.

Odomzo Support™

The Odomzo Support Patient Assitance Program application is used to verify patients' health insurance benefits and out-of-pocket costs for Odomzo.

To enroll, fill out and fax the Odomzo Support Patient Assistance Program application (www.odomzo. com/savings) to 1.877.872.6575 to start the process. For more infor- mation or any questions, call the program at 1.844.5.ODOMZO (1.844.563.6696), Monday through Friday, 8:00 am to 8:00 pm ET.

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 87 Taiho Oncology

Taiho Oncology

Oncology-related product: Inqovi® (decitabine and cedazuridine) tablets, Lonsurf® (trifluridine and tipiracil) tablets

Patient and Reimbursement Assistance Website taihopatientsupport.com

PATIENT ASSISTANCE Patient Assistance Program • Call 1.844.TAIHO.4U The patient assistance program can (1.844.824.4648), Monday Taiho Oncology Patient provide financial assistance to eligible through Friday, 8:00 am to 8:00 Support™ patients who have insufficient or pm ET, for help with enrollment. Accessing treatments can be chal- no prescription insurance. Eligible lenging at times. Taiho Oncology patients may receive Taiho oncology Once enrolled, healthcare profes- Patient Support offers personalized products at no cost based on assis- sionals can expect a Taiho Oncology services to give patients, caregivers tance, financial, and medical criteria. Patient Support reimbursement and healthcare professionals the specialist to confirm the patient’s help they need in getting started Alternate Funding Support enrollment and share next steps. with Taiho oncology products. This Taiho Oncology Patient Support can Patients can expect a welcome to the includes insurance verification, help also refer eligible, public- or govern- program and explanation of their with medication costs, and treatment ment-insured patients to nonprofit insurance benefits for their pre- plan support. foundations for co-pay or other scribed Taiho oncology product. assistance. Taiho Oncology does not Co-pay Assistance Program influence or control the decisions of REIMBURSEMENT Eligible patients may pay $0 per these co-pay assistance foundations. ASSISTANCE treatment cycle. Patients may be Each foundation has its own criteria eligible if they: for patient eligibility. Taiho Oncology Taiho Oncology Patient • Have commercial prescription cannot guarantee financial assistance Support™ insurance coverage once a patient has been referred. The Taiho Oncology Patient Support • Reside within the United States, program simplifies access for those Puerto Rico, or U.S. territories There are three ways to enroll in who have been prescribed a Taiho • Use a specialty pharmacy or Taiho Oncology Patient Support: oncology product as part of their hospital outpatient pharmacy • Complete the Patient Enrollment treatment. Just a phone call away, • Receive medication from a Form (www.taihopatientsupport. it can help determine insurance doctor’s office. com/how-to-enroll), Spanish coverage, coordinate prescriptions, enrollment forms are avialable and more. Patients are not eligible for online, and fax the form to the co-pay program if they are 1.844.287.2559. Access and Reimbursement reimbursed under Medicaid, a Medi- • Complete the enrollment forms Support caredrug benefit program, TriCare, online and upload them to The program can help patients or other state or federal programs. the healthcare professional understand their insurance coverage To determine patient eligibility, go portal (https://taihooncolo- and/or out-of-pocket responsi- to TaihoOncologyCopay.com or call gyhcp.caremetx.com/account/ bility through benefit verifications, 844.TAIHO.4U (844.824.4648) logonsupport). determine prior authorization

88 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 89 Taiho Oncology

requirements of the insurance company, and assist with appeals if coverage is denied.

Pharmacy Coordination The Taiho Oncology Patient Support program can also triage patients’ prescriptions, coordinate prescrip- tions with the specialty pharmacy, self-dispensing practice, or hospital outpatient pharmacy, and commu- nicate regularly with patients about prescription status.

To enroll, complete the Patient Enrollment Form (www.taihopa- tientsupport.com/financial-support), Spanish forms are available online, and fax it to 1.844.287.2559. Or healthcare professionals can complete the enrollment forms online and upload them to the portal (https://taihooncologyhcp. caremetx.com/). For help, call 1.844. TAIHO.4U (1.844.824.4648).

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 89 Takeda Oncology

Takeda Oncology

Oncology-related products: Alunbrig® (brigatinib) tablets, Iclusig® (ponatinib) tablets, Ninlaro® (ixazomib) capsules, Velcade® (bortezomib) for injection

Patient and Reimbursement Assistance Websites here2assist.com/patient/home velcade.com/paying-for-treatment

PATIENT ASSISTANCE 8:00 pm ET or visit here2assist.com/ tions apply. patient/home. Takeda Oncology To enroll, visit takedaoncologycopay. Here2Assist™ Takeda Oncology Co-Pay com or call Takeda Oncology Takeda Oncology Here2Assist is Assistance Program Here2Assist case manager at a comprehensive support program For patients with commercial 1.844.817.6468. committed to helping patients insurance concerned about their out- navigate coverage requirements, of-pocket costs for Alunbrig, Iclusig, Takeda Oncology Patient identify available financial assis- and Ninlaro, the Takeda Oncology Assistance Program tance, and connect with helpful Co-Pay Assistance Program may be If patients do not have insurance or the resources throughout their able to help. Patients could pay as prescribed medication is not covered treatment. little as $10 per prescription with by their insurance, they may be eligible an annual maximum benefit of to receive their medication at no cost To enroll, download the Takeda $25,000. through this program. To be eligible Oncology Here2Assist Enrollment for the Patient Assistance Program, Form (here2assist.com/pdf/ This offer cannot be used if patients patients must meet certain financial Takeda_Oncology_Here2Assist_ are a beneficiary of, or any part and insurance coverage criteria. Enrollment_Form.pdf) and fax the of their prescription is covered or completed and signed form with a reimbursed by: (1) any federal or A Patient Assistance Program copy of the patient’s insurance card state healthcare program (Medicare, Application (here2assist.com/pdf/ and prescription to 1.844.269.3038. Medicaid, TriCare, Veterans Takeda_Oncology_Patient_Assis- Prescription is only valid if received Administration, Department of tance_Program_Enrollment_Form. by fax. Defense, etc.), including a state or pdf) must be submitted in order to territory pharmaceutical assistance confirm patient eligibility. Original After the patient’s enrollment form program, (2) the Medicare Pre- signatures are required. Fax the is received and processed, a Takeda scription Drug Program (Part D), completed and signed application Oncology Here2Assist case manager or if patients are currently in the form along with a valid prescription will conduct a benefits verification to coverage gap, Medicare Advantage to Takeda Oncology Here2Assist at determine the patient’s prescription Plans, Medicaid Managed Care or 1.844.269.3038. coverage and potential out-of-pocket Alternative Benefit Plans under the costs. A summary of coverage will Affordable Care Act, or Medigap, If the patient qualifies, they may be be provided to the provider’s office or (3) insurance that is paying the enrolled for up to one year. Upon within two business days. For more entire cost of the prescription. enrollment, a Takeda Oncology information, call 1.844.817.6468, Patients must be at least 18 years Here2Assist case manager will notify Monday through Friday, 8:00 am to old. Additional terms and condi- the patient and their healthcare

90 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 91 Takeda Oncology

provider. A one-month supply of To enroll, download the Takeda their medication will be delivered to Oncology Here2Assist Enrollment the patient at no cost. Each month a Form (here2assist.com/pdf/ Takeda Oncology Here2Assist case Takeda_Oncology_Here2Assist_ manager will confirm with patients Enrollment_Form.pdf) and fax and their providers that they are the completed and signed form still being treated and are eligible to along with a copy of the patient’s receive another month’s supply of insurance card and prescription to medication. 1.844.269.3038. Prescription is only valid if received by fax. Call RapidStart Program 1.844.817.6468, option 2, Monday If patients experience a delay in through Friday, 8:00 am to 8:00 pm insurance coverage determination ET, for more information. of at least five days, they may be eligible to receive a one-month Velcade Reimbursement supply of their medication at no Assistance Program cost. To receive a RapidStart supply, Tekeda Oncology Here2Assist can a completed Takeda Oncology Here- provide the information needed 2Assist Enrollment Form must be on throughout patients’ treatment. Case file, and a RapidStart Request Form managers can connect patients and must be completed and submitted providers to personalized support (drug-specific forms are available at for Velcade. Call to speak to a case here2assist.com/patient/home). manager at 1.844.817.6468, option 2, Monday through Friday, 8:00 am Velcade Reimbursement to 8:00 pm ET or visit www.Here- Assistance Program 2Assist.com. From finding financial assistance to understanding their disease, Tekeda Oncology Here2Assist can provide the information needed throughout patients’ treatment. Case managers can connect patients and providers to personalized support for Velcade. Call to speak to a case manager at 1.844.817.6468, option 2, Monday through Friday, 8:00 am to 8:00 pm ET or visit www.Here2Assist.com.

REIMBURSEMENT ASSISTANCE Takeda Oncology Here2Assist™ Once enrolled in Takeda Oncology Here2Assist, case managers can work with patients and their healthcare provider to determine their coverage options and provide additional support throughout their treatment.

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 91 TerSera Therapeutics

TerSera Therapeutics

Oncology-related products: Varubi® (rolapitant) tablets, Zoladex® (goserelin acetate implant)

Patient and Reimbursement Assistance Website terserasupportsource.com

PATIENT ASSISTANCE TerSera Patient Assistance To apply for patients prescribed Program Varubi, download the enrollment TerSera Support Source TerSera is committed to helping form (documents.tersera.com/ TerSera is committed to help remove eligible patients access Zoladex or varubi/VarubiEnrollmentForm. the financial and access barriers that Varubi through the Patient Assis- pdf) and fax the completed form so often get in the way of patients tance Program. If patients qualify, to 1.855.836.3066. For more who are prescribed Zoladex and they may get free TerSera medicine information, call 1.855.686.8725, Varubi. for up to one year. TerSera will send Monday through Friday, 8:00 am to an application for renewal once 8:00 pm ET. Co-Pay Assistance patients’ enrollment ends. Medicines Eligible, commercially insured and can be sent to patients’ home or REIMBURSEMENT cash paying patients pay as little as their doctor’s office; most medicines ASSISTANCE $0 of their co-pay or coinsurance are sent in a 90-day supply. Patients amount. For Varubi, the card may qualify for the program if they: TerSera Support Source carries a $200 max cap per fill and • Are a Unites States resident, or a TerSera Support Source is committed a maximum benefit of $2,000 per Green Card or Work Visa holder to providing services that streamline calendar year. For Zoladex, the • Meet certain household income the approval process, including card carries a maximum benefit of limits prior authorization information and $2,000 per calendar year. Eligible • Do not have prescription drug appeals support. cash paying patients will receive coverage that helps pay for their up to $300 off each one month TerSera medicines. Visit terserasupportsource.com for supply of Zoladex. Patients are more information. not eligible if prescriptions are To apply for patients prescribed paid by any state or other federally Zoladex, complete the Patient funded programs, including but not Assistance Program enrollment limited to Medicare or Medicaid, form (zoladexhcp.com/pdf/patient- Medigap, VA, DOD, or TriCare, assist-enroll_form.pdf) and fax the or where prohibited by law. Visit form to 855.836.3066. For more activatethecard.com/7526 to enroll information on the patient assistance for Zoladex, or visit activateth- program for Zoladex, call 1.844. ecard.com/7774 to enroll for ZOLADEX (1.844.965.2339). Varubi. For questions regarding the Varubi or Zoladex co-pay card, call 1.844.864.3014, Monday through Friday, 8:00 am to 8:00 pm ET.

92 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 93 TEVA Oncology

TEVA Oncology

Oncology-related products: Bendeka® (bendamustine HCI) injection, Granix® (tbo-filgrastim) injec- tion, Synribo® (omacetaxine mepesuccinate) for injection, Treanda® (bendamustine hydrochloride) for injection, Trisenox® (arsenic trioxide) injection

Patient and Reimbursement Assistance Websites tevacares.org tevacore.com

PATIENT ASSISTANCE tance Programs, Teva may offer a • Templates for letters of medical reimbursement assistance program necessity Teva Cares Foundation or other type of program to assist • Teva Cares Foundation patient The Teva Cares Foundation is a patients. For more information, call assistance program referrals. group of patient assistance programs 888.TEVA.USA (888.838.2872). created to make a positive difference Some patients may be eligible for Download the CORE enrollment in the lives of patients and their assistance from other programs. form at tevacore.com/resources families. For decades, Teva has been For a listing of these other assis- and fax it to 866.676.4073. For working through its patient assistance tance programs go to tevacares.org/ questions, call 1.888.587.3263, programs to improve patient access otherresources/. Monday through Friday, 9:00 am to to medication and ensure that cost 6:00 pm ET or visit TevaCORE.com. is not a barrier to treatment. Teva’s REIMBURSEMENT commitment to patients provides ASSISTANCE certain Teva medications at no cost to patients in the United States who CORE meet certain insurance and income The reimbursement and insurance criteria. To determine if your patient process can be complicated. qualifies, review the Teva Cares Comprehensive Oncology Reim- Foundation Patient Assistance bursement Expertise (CORE) is Programs eligibility requirements available to help eligible patients, for the prescribed medication online their caregivers, and healthcare at tevacares.org/doiqualify or call professionals navigate the reim- 1.877.237.4881, Monday through bursement process. CORE offers a Friday, 9:00 am to 8:00 pm ET. Then range of services: download the appropriate enrollment • Benefit verification and coverage application for the prescribed medi- determination cation and fax the completed form to • Precertifications/prior authori- 877.438.4404. zation support • Coverage guidelines and claims If a patient does not meet the eli- investigation assistance gibility requirements for the Teva • Support through the claims and Cares Foundation Patient Assis- appeals process

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 93 6 STEPS to IMPROVE CARE COORDINATION for Lung Cancer Patients on Medicaid

1. Take the FREE, online assessment 1. (the Model) to identify 12 areas in which your program can improve care coordination and quality for patients with lung cancer.

2. See how your program 2. measures up. Download a customized PDF report with your results embedded in each assessment area and a crosswalk to more than 100 quality measures.

3. Discuss the results with your 3. care team and cancer program leadership to identify quality improvement (QI) opportunities.

4. Access ACCC-curated resources to 5. Gain more team training on 6. Share how your program is 4. help make the case for developing 5. the building blocks of successful 6. utilizing the Model’s framework and implementing a QI project in QI project development to improve care coordination and one or more assessment areas, and implementation. Available by applying for an ACCC Innovator such as patient access, navigation, to a select number of ACCC Award, submitting an article to supportive care, multidisciplinary Cancer Program Members. Oncology Issues, or applying to treatment planning, and more. present at an upcoming meeting.

Access the online tool, full Model & quality measures report, and testimonials from ACCC members who have used their assessment for quality improvement initiatives. carecoordination.accc-cancer.org

94 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 95 ACCC 47th ANNUAL MEETING 6 STEPS & CANCER CENTER BUSINESS SUMMIT to IMPROVE CARE March 1–5, 2021 COORDINATION AMCCBS Virtual for Lung Cancer Patients on Medicaid POSITIVE DISRUPTION in the COVID-19 Era 1. Take the FREE, online assessment (the Model) to identify 12 areas in AMCCBS Virtual will deliver a focused look at the which your program can improve care coordination and quality for hot button issues impacting your cancer program patients with lung cancer. today—and the strategies you’ll need to emerge positioned for success. 2. See how your program 2. measures up. Download a customized PDF report with Explore timely, real-world case studies that your results embedded in demonstrate how to accelerate digital health each assessment area and a crosswalk to more than capabilities, transform business operations and 100 quality measures. care processes, and enhance the patient and provider experience in this new reality. 3. Discuss the results with your 3. care team and cancer program leadership to identify quality Cancer Care Delivery in a COVID-19 World improvement (QI) opportunities. Telehealth, Virtual Care Models, and Remote Monitoring Cancer Service Line Efficiency and Revenue 4. Access ACCC-curated resources to 5. Gain more team training on 6. Share how your program is Optimization 4. help make the case for developing 5. the building blocks of successful 6. utilizing the Model’s framework and implementing a QI project in QI project development to improve care coordination and Community Approaches to Addressing Diversity one or more assessment areas, and implementation. Available by applying for an ACCC Innovator and Inclusion such as patient access, navigation, to a select number of ACCC Award, submitting an article to supportive care, multidisciplinary Cancer Program Members. Oncology Issues, or applying to Managing Risk and Innovative Staffing Strategies treatment planning, and more. present at an upcoming meeting. New Models in Clinical Trials and Cancer Research Business Consolidation: Opportunities and Obstacles

Access the online tool, full Model & quality measures report, and testimonials from Join us at accc-cancer.org/AMCCBS for agenda updates, registration rates, and more as the #AMCCBSVIRTUAL ACCC members who have used their assessment for quality improvement initiatives. program develops in real-time. carecoordination.accc-cancer.org

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 95 Adaptive Biotechnologies

Adaptive Biotechnologies

Oncology-related products: clonoSEQ® Assay (for the detection and monitoring of minimal residual disease in bone marrow samples from multiple myeloma and B-cell acute lymphoblastic leukemia patients)

Patient and Reimbursement Assistance Website clonoseq.com/adaptive-assist

PATIENT ASSISTANCE patients under the age of 18 are cation. An incomplete form may eligible, but require the appli- result in delays to processing and/ Adaptive Assist™ cation form to be signed by a or enrollment. For more infor- Adaptive Biotechnologies under- parent or legal guardian mation call 1.855.236.9230 or visit stands that each patient’s situation is • Be uninsured or have insurance clonoseq.com/adaptive-assist. unique. It is committed to providing that does not cover the full cost of guidance and support during each step clonoSEQ testing REIMBURSEMENT of the insurance process. That’s why • Meet financial need requirements ASSISTANCE it offers the Adaptive Assist Patient based on the patient’s income and Support Program: to help facilitate the number of persons in their Adaptive Assist™ access to clonoSEQ testing services household or sum of medical The Adaptive Assist Patient Support for patients who could benefit from expenses as a percentage of Program is a comprehensive reim- the clinical insights provided by household income bursement support program to next-generation measurable residual • Submit a completed and signed support patients for the duration disease testing. Adaptive Assist can application form (www.clonoseq. of their measurable residual disease help through the following support: com/adaptive-assist/) including testing. The program: • Understand coverage acknowledgment of the require- • Aids patients to understand the • Navigate insurance ment to submit a tax return, W-2, pay billing process and potential out- • Individualized support. stub, or other comparable document of-pocket costs demonstrating financial need if and • Assists with prior authorizations For questions, call the program at when selected for participation in for all incoming clinical orders 1.855.236.9230, Monday through the upfront enrollment audit. • Appeals for the maximum benefits Thursday, 9:00 am to 7:00 pm ET, and lowest out-of-pocket cost and Friday, 9:00 am to 5:00 pm ET. Neither the application nor the • Assists with out-of-pocket costs Patient Support Program constitute after coverage. Patient Support Program a contract. Adaptive Biotechnol- Adaptive Biotechnologies is committed ogies retains the right to change the To get patients started, download to providing financial assistance program in whole or part at any time the program applications (www. opportunities to qualified clonoSEQ in the exercise of its sole discretion. clonoseq.com/adaptive-assist/) to patients with a demonstrated financial find out if they qualify for support. need and in accordance with the terms In most cases, Adaptive Biotech- Call 1.855.236.9203, Monday of the Patient Support Program. To be nologies will send a notification through Thursday, 9:00 am to 7:00 eligible for enrollment, a patient must letter indicating final program pm ET, and Friday, 9:00 am to meet all of the following criteria: eligibility determination within 10 5:00 pm ET, for answers to your • Be a United States citizen or legal working days following receipt of questions about insurance, billing, resident age 18 years or older; a fully completed and signed appli- payment, or financial assistance.

96 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 97 Foundation Medicine

Foundation Medicine

Oncology-related products: FoundationOne® CDx (companion diagnostic for patients across all solid tumors), FoundationOne® Liquid CDx (liquid biopsy test for solid tumors), FoundationOne® Heme (genomic profiling test for hematologic malignancies and sarcomas)

Patient and Reimbursement Assistance Website foundationmedicine.com/info/detail/for-patients

PATIENT ASSISTANCE Financial Assistance Foundation Medicine is committed to helping patients access its testing services. Financial assistance is available for patients based on need and can be applied for at any point during the testing process. If patients are uninsured or concerned about the out-of-pocket cost of testing, fill out a financial assitance application or contact Foundation Medicine at 888.988.3639, Monday through Friday, 8:00 am to 8:00 pm ET. Apply for assistance online or download the PDF application (both can be found under “Financial Support” at www.foundationmedicine.com/ info/detail/for-patients). If filling out the PDF application, fax it to 1.617.830.0279 or email it to client. [email protected].

Some commercial health plans offer coverage for Foundation Medicine testing services. Medicare covers FoundationOne CDx, FoundationOne Liquid CDx, and FoundationOne Heme for qual- ifying patients. FoundationOne CDx is also covered by TriCare for qualifying patients. FoundationOne Heme has limited commercial health plan coverage at this time.

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 97 ASSOCIATION OF COMMUNITY CANCER CENTERS

FINANCIAL ADVOCACY NETWORK One-third of respondents (36%) said they “do not have enough 1/3 full-time employees (FTEs) to meet their demand for financial advocacy services” and another 2019–2020 ACCC third (34%) said they “do not ALWAYS have enough FTEs to meet their demand for Financial Advocacy Network financial advocacy services.” n=183 Census Survey 292 survey respondents from 153 unique cancer programs and practices 60% How many dedicated financial advocates work at your cancer program? n=284

Who Took Our Survey n=292 • 1 to 3 FTEs • 6+ FTEs • Financial counselor/ • Oncology social • 4 to 5 FTEs Navigator worker • None Oncology nurse/ Oncology pharmacist • • Hiring our first Nurse navigator • Hospital administrator • • Other • Other

13% 13% 3% 53% 21% 12% 5% 6% 10% 5% 2% Years of Experience Providing Financial Navigation Services n=270

48% Less than 5 years 23% 5-10 years Roles and Responsibilities n=192 22% 11-20 years • Work directly with patients to address financial concerns 7% 20+ years Screen patients for their risk of financial toxicity and/or distress • • Identify and enroll patients in manufacturer financial assistance • Identify and enroll patients in free-drug programs

One-third of respondents say

1/3 they provide financial advocacy services to more than

20 patients per week. 74% 64% 61% 59% n=183

98 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 99 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 99 ACCC 37th [VIRTUAL] National Oncology Conference

STRATEGIES FOR THE CANCER CARE TEAM

You’ll Have Access To: • Featured Speakers who will inspire you to become an effective leader The Same during times of adversity and adopt strategies that can help address the disparity of women in the field of oncology. Exceptional • ACCC Innovator Award Winners that offer practical takeaways and replicable strategies for administrators, physician and nurse leaders, Programming. pharmacists, and other members of the cancer care team looking to improve the patient experience. NOW AVAILABLE • Hot-Topic Roundtable Sessions on Culture Humility and Sensitivity, Engaging Physicians in Clinical Trials, Meeting the Needs of AYAs, ON-DEMAND. Wellness Strategies, Mentoring Those New to Oncology, and more. • On-Demand Activities for 12 months, which award continuing education hours for physicians, nurses, pharmacists, and administrators as appropriate!

LEARN MORE AT COURSES.ACCC-CANCER.ORG/NOC ASSOCIATION OF COMMUNITY CANCER CENTERS 880+ FINANCIAL cancer programs ADVOCACY and practices 2,325+ enrolled NETWORK participants in 50 states

Financial Advocacy Boot Camp Powerful Training to Boost Your Financial Navigation Services!

Two sets of dynamic online courses offer the tools your staff needs to help patients pay for treatment— “The Financial Advocacy Boot Camp explains all aspects while maximizing reimbursement at your program. of financial advocacy and is a great tool for new advocates and experienced professionals. Our team Shape up your team's skills with introductory courses: will be more prepared and confident with this tool.”

• Financial Advocacy Fundamentals Angie Santiago, CRCS-I, Lead Financial Counselor–Oncology, • Enhancing Communication Thomas Jefferson University Health System, Sidney Kimmel Cancer Center • Improving Insurance Coverage • Maximizing External Assistance • Developing and Improving Financial Advocacy Programs and Services Who Should Enroll? Financial advocates, nurses, patient navigators, social workers, Then continue the learning with advanced content: pharmacists and techs, medical coders, administrative staff, cancer program administrators, and other healthcare professionals. • Oncology 101 for Financial Advocates • Proactive Assessment of Financial Distress Cost • Cost-Related Health Literacy FREE to ACCC and Oncology State Society at ACCC members, • Measuring and Reporting and $155 for non-members. Join ACCC as an Individual Member ($155) to access this resource—and others—for free. Additional course to be released in 2020: • Health Policy Landscape ENROLL at accc-cancer.org/FANBootCamp

The ACCC Financial Advocacy Network is supported by:

Cornerstone Partner Silver Partners

The Association of Community Cancer Centers (ACCC) is the leading education and advocacy organization for the cancer care community. Founded in 1974, ACCC is a powerful network of 25,000 multidisciplinary practitioners from 2,100 hospitals and practices nationwide. As advances in cancer screening and diagnosis, treatment options, and care delivery models continue to evolve—so has ACCC—adapting its resources to meet the changing needs of the entire oncology care team. For more information, visit accc-cancer.org or call 301.984.9496. Follow us on Facebook, Twitter, and LinkedIn; read our blog, ACCCBuzz; and tune in to our podcast, CANCER BUZZ.

The ACCC Financial Advocacy Network is the leader in providing professional development training, tools, and resources that will empower providers to proactively integrate financial health into the cancer care continuum and help patients gain access to high quality care for a better quality of life. Other Patient Assistance Programs & Resources

Other Patient Assistance Programs & Resources

Agingcare.com® tance, transportation for healthcare, • Housing agingcare.com and more. • Income Assistance • Tax relief AgingCare.com connects A program or foundation’s eligi- • Transportation families with elder care, senior bility will be listed along with its • Employment. housing, and cargiver support. contact information. Aunt Bertha Included in its services is the will provide “Next Steps” to If patients have Medicare and have Drug Assistance Program help patients with the application limited income and resources, they Locator: agingcare.com/Articles/ process. may be eligible for the Medicare Part prescriptiondrugassistance-program- D Low-Income Subsidy or Extra ocator-171753.htm. Search for BenefitsCheckUp® Help. Patients may be able to get prescription drug assistance benefitscheckup.org extra help paying for prescription programs by state, medication drug costs if: name, or browse a list of nationwide The National Council on Aging • Their income is less than $19,380 non-profit prescribed medication (NCOA) is a respected national if single and $26,100 if married. assistance programs. leader and trusted partner helping • They have resources less than older adults meet the challenges $14,610 if single and $29,160 if Aunt Bertha of aging through services like married. findhelp.org BenefitsCheckUp. BenefitsCheckUp is a comprehensive, free online tool To apply, patients must live in Aunt Bertha has created a social that connects older adults with one of the 50 states or the District care network that connects people benefits they may qualify for. The of Columbia. Apply online at: and programs—making it easy for BenefitsCheckUp team monitors the benefitscheckup.org/medicare-rx-ex- people to find social services in benefits landscape for updates and tra-help-application-welcome. their communities, for nonprofits changes to policies and programs. to coordinate their efforts, and for It matches patients’ unique needs CancerCare® customers to integrate social care to benefit programs and eligibility cancercare.org into the work they already do. requirements using its compre- hensive tool. CancerCare is the leading national Its interactive map (company. organization providing free, pro- auntbertha.com/for-customers/ There are over 2,500 federal, state, fessional support services and socialcarenetwork/) illustrates and private benefits programs information to help people manage comprehensive coverage of social available to help. After reviewing the emotional, practical and care programs in every United States initial results, patients can enter financial challenges of cancer. Its county, including state and national more details to personalize their comprehensive services include programs. Select any county to view report. They will receive a cus- case management, counseling and the breakdown of program cate- tomized report listing the benefits support groups over the phone, gories (such as housing and financial they are most likely to qualify online, and in-person, educational assistance) and use the map filter to for. Patients can start enrolling workshops, publications, and select interactive geographic areas. in programs right away. Benefits- financial and co-payment assistance. CheckUp can help patients with the All CancerCare services are provided The open access search (findhelp. following types of expenses: by master's-prepared social workers org) is free, open to the public, • Medication and world-leading cancer experts. and easy to use. After searching by • Food It offers limited financial assis- zip code, Aunt Bertha lists several • Utilities tance for cancer-related costs such options in the community that can • Education as transportation and child care. help patients with prescription assis- • Healthcare If applying for financial assistance,

102 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 103 Other Patient Assistance Programs & Resources

all correspondence must be done CancerCare® Co-Payment dation is to use the online process electronically through email or fax. Assistance Foundation (cancercare.org/copay-apply) or CancerCare does not have access to cancercarecopay.org speak with a Co-Payment Specialist process any incoming or outgoing at 866.55.COPAY (866.552.6729). mail. As a non-profit organization, CancerCare helps people with Patients will be enrolled for up to funding depends on the sources of cancer overcome financial access one year from the time they are support CancerCare receives at any and treatment barriers by assisting approved. given time. If CancerCare does not them with co-payments for their currently have funding to assist a prescribed treatments. It offers For more information, call 866.55. patient, professional oncology social easy-to-access, same-day approval COPAY (866.552.6729), Monday workers will always work to refer over the phone and online. To through Thursday, 9:00 am to patients to other financial assistance qualify for assistance, patients must 7:00 pm ET, and Friday, 9:00am resources. Check cancercare.org meet certain financial, medical to 5:00 pm ET. periodically for funding updates. and insurance criteria. The funds are disease specific. The patient’s Cancer Financial Financial Assistance Program primary cancer diagnosis must Assistance Coalition In order to be eligible for financial match our fund definition and the cancerfac.org assistance, patients must: medication prescribed must be • Have a diagnosis of cancer to treat the primary diagnosis. If The Cancer Financial Assistance confirmed by an oncology CancerCare Co-Payment Assistance Coalition (CFAC) is a coalition healthcare provider Foundation (CCAF) does not have of financial assistance organiza- • Be in active treatment for cancer funds available for a specific disease, tions joining forces to help cancer • Live in the U.S. or Puerto Rico it will provide you with information patients experience better health • Meet CancerCare eligibility guide- about other patient assistance and well-being by limiting financial lines based on the Federal Poverty programs, support services, and challenges. It educates patients and Limit. additional resources that may be providers about existing resources helpful. and links to other organizations Steps for applying to this program, that can disseminate information include: In order to be eligible for assistance: about the collective resources of its 1. Call 800.813.HOPE (4673) • Patient’s primary cancer diagnosis member organizations. and speak with a CancerCare must be the same as one of the social worker to complete a brief funds that CCAF covers. CFAC is a coalition of organizations interview. They can be reached • Patient must have a valid Social and cannot respond to individual Monday through Thursday, 10:00 Security number to apply for assis- requests for financial assistance. To am to 6:00 pm ET, and Friday, tance and receive treatment in the find out if financial help is available, 10:00 am to 5:00 pm ET. United States. use the CFAC database at cancerfac. 2. If patients are eligible to apply, • Patient must be in active treatment org. Search by cancer diagnosis or CancerCare will: or have a treatment plan in place by specific type of assistance or need • Mail/email the patient an prior to applying for assistance. (i.e., co-pays, general living expenses, individualized barcoded • Patient is required to have valid transportation, genetic testing). application insurance coverage. Some funds Patients and providers may also • Request documentation to are restricted to assist only those contact each CFAC member organi- verify the patient’s income. insured through a federal health zation individually for guidance and 3. Patients must submit a completed insurance program such as possible financial assistance. application to the email or fax Medicare or TriCare. number listed on the form. • Patient income level must be at or Co-Pay Relief below 500 percent of the Federal copays.org Poverty Level. The Patient Advocate Foundation The quickest and most secure way (PAF) Co-Pay Relief Program (CPR) to enroll a patient with the foun- provides direct financial assistance

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 103 Other Patient Assistance Programs & Resources

to qualified patients with co-pay- receive a lower price. FamilyWize Good Days® ments, co-insurance, or cost-sharing understands patients are looking to mygooddays.org associated with prescription med- reduce the cost of prescription medi- ications through funds dedicated cations, and its goal is to help people Good Days is a non-profit advocacy to specific disease states. In some do that. The pharmacy discount card organization that provides resources instances, assistance with insurance is for everyone nationwide, whether for life-saving and life-extending premiums and/or ancillary services or not patients have health insurance treatments to people in need of associated with the disease also may coverage. access to care. be available. Patients approved for assistance are required to have their The free FamilyWize Prescription Good Days covers what insurance verified diagnosis and treatment Discount Card (familywize.org/ does not—the co-pays for treat- plan along with supporting docu- free-prescription-discount-card) is ments that can extend life and mentation completed and returned available online or through mobile alleviate suffering. Good Days also within 30 days of approval to app. There are no fees or eligibility has a premium assistance program ensure continuation of the award. requirements. This program can for patients who need help paying Eligibility requirements: be used to obtain savings on pre- their monthly medical insurance • Patients must be currently insured scription drugs that are excluded premiums. Its travel assistance and have coverage for medica- by insurance plans, not covered program helps pay for travel costs tion(s) seeking financial assistance. because patients have exceeded their to ensure patients have access to the • Patients must have a confirmed plan’s maximum limits, or the free care they need. diagnosis and treatment plan. prescription discount card’s price • Patients must reside and receive is lower than a patient’s program’s Good Days has streamlined the treatment in the United States. co-payment amount. enrollment process so patients can • Patients’ income must fall at or receive immediate determination of below 300 percent or 400 percent The prescription discount card must eligibility for financial assistance. of the Federal Poverty Guideline be presented with each prescription Eligibility criteria: (FPG) with consideration for the to a participating pharmacy to be • Patient must be diagnosed with a Cost of Living Index (COLI) and eligible for the discount price. The covered disease and program must number in the household. price the cardholder pays is always be accepting enrollments the lesser of the discounted price • Patient must have a valid Social Once approved, the award can be or pharmacy’s retail price. If the Security number to apply for assis- used immediately. Claims should be pharmacy’s price is less, there is tance and receive treatment in the submitted via the Virtual Pharmacy no discount. The card can-not be United States Card, uploading them to the online used with other prescription drug • Patient must be seeking assistance portal, or faxed to PAF using the discount cards or for prescriptions for a prescribed medication that unique bar-coded fax cover sheet. paid through a health plan or is FDA approved to treat the pharmacy benefit plan. All pricing covered diagnosis Patients and providers can apply and benefits are subject to change • Patient is required to have valid online (https://copays.org/portal/#/ without notice. Additional restric- insurance coverage login) or by calling 866.512.3861. tions may apply. • Patient income level must meet If applying via phone, applications program guidelines. and supporting documents must be With the Drug Price Look-up Tool faxed to the unique bar-code on the (familywize.org/drug-price-look- To enroll, go to mygooddays.org/ application. up-tool), patients can enter the apply to apply online, or you can name of their medication and zip download the English or Spanish FamilyWize® code, and it will show them the enrollment form and fax completed familywize.org pharmacy savings for that specific forms to 214.570.3621. Good medication. Days' care navigators are available FamilyWize partners with nearly all to assist by phone at 877.968.7233, pharmacies nationwide to negotiate Learn more at familywize.org, or Monday through Friday, 8:00 am to prescription discounts, so patients call 800.222.2818 5:00 pm CT.

104 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 105 Other Patient Assistance Programs & Resources

HealthWell Foundation® HealthWell strongly encourage • Have a household income at or healthwellfoundation.org providers, advocates, social workers, below 500 percent of the U.S. and pharmacy staff to use their Federal Poverty Guidelines as ad- When health insurance is not enough, respective portal to apply so that justed by the Cost of Living Index HealthWell Foundation fills the gap patients can readily access its hotline • Be a United States citizen or by assisting with copays, premiums, care managers. permanent resident of the U.S. or deductibles, and out-of-pocket U.S. territory expenses. It provides financial assis- Once patients are approved for a • Have medical and/or prescription tance to help with: grant from one of the disease funds, insurance • Prescription copays they will receive assistance for a • Have a blood cancer diagnosis • Health insurance premiums, rolling 12 months, after which they confirmed by a doctor. Patient deductibles, and coinsurance can reapply if needed and if funding is must be in active treatment, • Pediatric treatment costs available. Upon approval, patients will scheduled to begin treatment, or is • Travel costs. receive both a HealthWell Pharmacy being monitored by their doctor. Card and a Reimbursement Request (See a list of covered diagnoses at Healthwell Foundation offers Form for times when they need it. lls.org/support/financial-support/ financial assistance through a number co-pay-assistance-program). of disease funds, with new funds For any questions and to speak with opening every year, so patients can a HealthWell representative, call Patients, providers, pharmacies can get the care they need. 800.675.8416, Monday through apply online using the LLS Financial Friday, 9:00 am to 5:00 pm ET. Assistance Copay Portal (https:// To be eligible, patients must meet cprportal.lls.org/#/login). certain criteria: The Leukemia & • HealthWell must have a disease Lymphoma Society Patients and providers call also fund that covers the patient’s illness, Co-Pay Assistance Program apply over the phone and get more and their medication must be an lls.org information about the LLS Co-Pay eligible treatment for that illness. Assistance Program by calling • Patients must have some form of The Leukemia & Lymphoma 877.557.2672, Monday through health insurance such as, private Society (LLS) Co-Pay Assistance Friday, 8:30 am to 5:00 pm ET. insurance, Medicare, Medicaid, Program can help provide assis- or TriCare that covers part of the tance and pay a patient's provider Support for this program is based on cost of the treatment. directly or reimburse them for the availability of funds by disease • Patients have incomes up to 400 payments already made. Patients diagnosis. percent to 500 percent of the have the complete freedom to federal poverty level (HealthWell choose their doctors, providers, Patient Aid Program considers household income, the suppliers, insurance companies, The Patient Aid Program provides number in the household, and the and treatment-related medications. financial assistance to blood cancer cost of living in the patients' city Patients can make changes to these patients. Eligible patients will receive or state). at any time without affecting their a one-time $100 stipend to help • Patients must be receiving treatment continued eligibility. The LLS offset expenses. There are no income in the United States. Co-Pay Assistance Program offers criteria to qualify for this program. financial help toward: Program continuation is dependent Anyone with the patient’s express • Medical insurance premiums on the availability of funds and the permission may apply on behalf of a • Treatment-related co-pays, program could be modified or dis- patient in two ways: deductibles, and co-insurance (for continued at any time if funding is 1. Apply online using the HealthWell expenses covered by the program) limited or no longer available. To be provider portal at https://healthwell- • Prescription medication related to eligible, patients must: foundation.secure.force.com/ prescribed treatment. • Be a United States citizen or 2. Apply by phone at 800.675.8416, permanent resident of the U.S. Monday through Friday, 9:00 am To be eligible for Co-Pay Assistance, or U.S. territories to 5:00 pm ET. patients must:

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 105 Other Patient Assistance Programs & Resources

• Have a confirmed diagnosis sec=all-resources&cat=3 needymeds.org/local-programs. You of blood cancer, be in active • Information about the cost can find local programs in two ways: treatment, scheduled to begin of prescription medicines at 1. Enter the patient’s zip code to find treatment, or in follow up care, all medicineassistancetool.org/ a program in their area or attested to by the patient or care Medicine-Cost-Information. 2. Search by state. team memeber • Patients may be insured or NeedyMeds If a medicine does not appear on uninsured. needymeds.org the brand name or generic name lists, then it is not available through a PAP. Apply online (lls.org/support/finan- NeedyMeds is a non-profit that Other assistance options include: cial-support/patient-financial-aid) connects people to programs that • Coupons, Rebates & More lists or by phone at 877.557.2672, will help them afford their medi- offers of brand name medicine Monday through Friday, 8:30 am cations and other healthcare costs. (over-the-counter and pre- to 5:00 pm ET. Each program has its own qualifying scription) and medical supplies. criteria. To find a patient assistance These offers may be in the form Medicine Assistance Tool program (PAP) that patients may of a printable coupon, rebate, medicineassistancetool.org qualify for click on the brand name savings card, 7-30 day free trial or generic name search page under offers, or free samples. There are Pharmaceutical Research and the “Patient Savings” tab on the a variety of ways to receive the Manufacturers of America’s NeedyMeds website, or search offers: some may be printed right Medicine Assistance Tool (MAT) for the medication name using the from their website, others require is a search engine designed to help search feature in the upper left hand registration, filling out a question- patients, caregivers, and health corner of the screen. If using the naire, or even obtaining a sample care providers learn more about brand or generic name medication from the doctor’s office. the resources available through search function: • NeedyMeds Drug Discount Card the various biopharmaceutical 1. Click on the first letter of the med- can help save up to 80 percent off industry programs. MAT is not its ication’s name in the alphabet bar. the price of prescription medica- own patient assistance program, 2. Click on the name of the medicine tions. No personal information but rather a search engine for many to access the eligibility and contact or registration is required and of the patient assistance resources information for the program(s). the drug discount card is free of that the biopharmaceutical industry charge. The discount card can be offers. PAPs can also be found by searching used immediately. Simply present the Program Name List or by the card to the pharmacist, along The tool has three steps: Enter Your looking through the Company Name with the prescription, at any of Medications, My Background and List, both found under the “Patient the participating pharmacies. My Resources. In the final step, Savings” tab on the NeedyMeds The drug discount card cannot users can review resources that may website. If an application form is be used in combination with any be available based on the medica- available through a PAP, look for it insurance, so it cannot be used to tions and background information in the “Program Applications” list. lower a copayment. Download entered. Resources will be listed and a card and learn more about its can be printed by the user. Program Application Assistance: benefits atwww.needymeds.org/ There are many local programs and drug-discount-card. MAT offers other resources, individuals that help people apply • Diagnosis-Based Assistance: including: to prescription assistance programs. There are many government and • A list of other healthcare assistance All will help for free or at a low privately-funded programs that resources at https://medicine cost. They may help with finding a help with costs associated with a assistancetool.org/My-Resources? program for prescription medica- specific diagnosis. Some programs sec=all-resources&cat=13 tions, completing the application are national in scope, while others • A list of discount drug card forms, and working with healthcare are limited to people in specific programs at https://medicine providers who must sign the states. Most have some type of assistancetool.org/My-Resources? forms. Help can be found at www. eligibility requirements, usually

106 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 107 Other Patient Assistance Programs & Resources

financial ones. Some cover one affordability. Patients and providers with the mission to identify and specific diagnosis, while others and pharmacy staff on the patient's reduce the challenges that indi- cover whole categories (such behalf can apply for assistance using viduals have when seeking care for as all types of cancers) or even the online self-service portals at their disease. Case management all chronic medical illnesses. www.panfoundation.org/get-help/ services are available on behalf of NeedyMeds has compiled a apply-for-assistance/ or by calling patients meeting all of the following database (www.needymeds.org/ 866.316.7263, Monday through criteria: copay-branch) of diagnosis-based Friday, 9:00 am to 7:00 pm ET. • Have a confirmed diagnosis of a assistance programs that can be chronic disease, a life-threatening searched. In most cases, it's best To qualify for a financial assistance disease, or debilitating disease, to search by the type of diagnosis. program, the patient must: or be seeking screening services Other ways to search for assis- • Be getting treatment for the related to symptoms or suspicion tance are by looking for programs disease named in the assistance of a chronic, life-threatening, or that serve a specific geographical program debilitating disease area. If you know the name of a • Be taking a medication that’s • Be in active treatment, had specific program about which you covered by their health insurance treatment within the past 6 want more information, you can and listed in the assistance months, or going into treatment in also search by name of program. program the next 60 days • Have an income that's at or below • Be a United States citizen or Assistance with the Federal Poverty Level specified permanent resident of the U.S. Government Programs: by the assistance program • Be receiving treatment at a facility Every state has programs to help • Live and receive treatment in the in the U.S. or in a U.S. territory. needy families and individuals with United States or U.S. territories. the cost of healthcare. NeedyMeds They don’t have to be a U.S. citizen. To connect with case management has compiled a database of programs services, call 1.800.532.5274 or and helpful tools and information to When applying for a PAN grant, apply online at patientadvocate.org/ navigate these programs. Users can patients are free to choose their connect-with-services/case- search these programs by clicking covered medications, healthcare management-services-and- on a state, the District of Columbia, providers, and pharmacies. And they medcarelines/. or U.S. territory. Programs and can make changes to these anytime their guidelines vary from state to without affecting your grant eligi- MedCareLine: A division of PAF, state. NeedyMeds also has a list of bility. PAN provides assistance on a the MedCareLine’s team of pro- Medicaid sites where you can learn rolling 12-month basis. fessional case managers assist with more about Medicaid in your state, disability, health insurance navi- as well as general information on For questions about applica- gation including prior authorization, Medicaid. tions or income verification, call appeals for denied services, second 1.866.316.7263. opinion options, and screening for For all questions, call 1.800.503.6897, clinical trials. The case managers or email [email protected]. Patient Advocate also assist patients who are expe- Foundation riencing financial challenges that Patient Access Network patientadvocate.org are impacting their ability to pay Foundation for care and basic cost of living panfoundation.org The Patient Advocate Foundation expenses like housing, utilities, food (PAF) is a non-profit charity that and transportation, researching and The Patient Access Network (PAN) provides direct services to patients linking them to available financial helps underinsured people with with chronic, life threatening, and support programs that may meet life-threatening, chronic, and rare debilitating diseases to help access care some of these needs. Uninsured diseases get the medications and treat- and treatment recommended by their patients are also supported by ments they need by assisting with doctor. It offers the following services: the program with direct support their out-of-pocket costs and advo- Case management services: Profes- in accessing public programs, cating for improved access and sional case managers at PAF work health insurance enrollment, and

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 107 Other Patient Assistance Programs & Resources

charity care that will allow access information they need. Go to rxassist. • An email address (this will become to necessary care. For more infor- org/search and search by either med- the user's login) mation, visit patientadvocate.org/ ication name or company name. • The medication for which the connect-with-services/case-manage patient is applying ment-services-and-medcarelines. If an application is available online, • The patient’s first and last name. users can either open (download) Co-Pay Relief Program: The PAF the application, type information Once the above information is Co-Pay Relief Program, one of the directly onto the application on available, go to rxhope.com/Prescriber/ self-contained divisions of PAF, the screen and print it out, or print Register.aspx and follow the instruc- provides direct financial assistance out the application and fill it out tions. You will be setting up your to insured patients who meet certain by hand. If there is no application free account and creating an order qualifications to help them pay for online, use the phone number for the patient all at the same time. the prescriptions and/or treatments provided at the top of the “Program they need. This assistance helps Details” page to call the company Patients can initiate the patient patients afford the out-of-pocket for information on how to get an assistance process by following a few costs for these items that their application. steps: insurance companies require. For 1. Enter contact information and more information, read the “Co-Pay RxAssist Prescription Savings select the medication for which Relief” on page XX. Card the patient is applying With the RxAssist Prescription 2. Review the program guidelines Financial Aid Funds: This inde- Savings Card, patients can save up and requirements that will be pendent division of Patient to 85 percent where they already listed on the screen Advocate Foundation provides fill their prescriptions. Savings are 3. Follow the instructions and print small grants to patients who meet possible with or without insurance, out the request for a healthcare financial and medical criteria. and there is no additional cost to use provider to complete. Grants are provided on first-come the card. RxAssist guarantees the first-served basis and are distributed lowest price between its discounted To complete the request, make sure until funds are depleted. Qualifica- price, patients' insurance copay, to click on the blue link that says tions and processes for each fund or the pharmacy cash price. Visit “Apply Online Now.” may differ based on fund require- rxassist.org/coupon/generic?type= ments. Patients who are interested patients, or call 1.877.537.5537 for Rx Outreach® in applying for financial assistance more information. rxoutreach.org should start by calling this division at 855.824.7941 or by registering RxHope™ Rx Outreach is a fully-licensed an account and submitting an rxhope.com non-profit mail order pharmacy application online at financialaid. that ships medications directly to patientadvocate.org. Healthcare providers and their staff patients’ homes or the provider’s can set up accounts online to order office. To make this process simple For questions, call 1.800.532.5274, free medications for their patients and cost-effective, RxOutreach ships Monday through Thursday, 8:30 am through the RxHope automated enough medication for 30, 60, 90, to 5:00 pm ET, and Friday, 8:30 am patient assistance online system. If or 180 days at a time. RxOutreach to 4:00 pm ET. providers and staff would like to is available to qualifying indi- create a free account for one healthcare viduals and families. Patients can RxAssist provider, visit rxhope.com/Prescriber/ be on Medicare, Medicaid, or other rxassist.org SetupAccount.aspx. To set up a free health insurance and still qualify. account and place orders online the It serves people whose income is RxAssist offers a comprehensive following criteria are required: at or below 400 percent of the database of patient assistance • The user must be a healthcare Federal Poverty Line. Patients programs, as well as practical tools, provider or their staff can quickly check their eligibilty news, and articles so that health care • A valid state license number for online at https://rxoutreach.org/ professionals and patients can find the the healthcare provider find-out-if-youre-eligible/.

108 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 109 Other Patient Assistance Programs & Resources

Patients or their advocates can complete a simple enrollment process online, by phone, or with our paper application. 1. Download and print the paper application (https:// rxoutreach.org/wp-content/ uploads/2020/09/RxOutreach_ Web-Application-9.20.pdf), and fax the completed form to 1.800.875.6591. Faxed prescrip- tions must come directly from the provider's office. 2. Create an account online at rxoutreach.org/how-to-enroll-in- rx-outreach/ 3. Call 1.888.RXO1234 (1.888.796.1234).

Once Rx Outreach receives the patient’s prescription and payment, it will do the rest. Medications are received about four days after prescriptions are approved. When it’s time for a patient to refill their prescription, it will send a reminder.

For any questions, call 1.888. RXO.1234 (1.888.796.1234), Monday through Friday, 7:00 am to 5:30 pm CT, or email questions@ rxoutreach.org.

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 109 ASSOCIATION OF COMMUNITY CANCER CENTERS

Improving Patient Communication sing the Ask e Tool

Ask Me3 encourages patients to ask 3 simple questions each time they talk to their care team ACCC has created a video to demonstrate how the cancer care team can most effectively use this tool with patients

Watch the ACCC Video! What is What do Why is it my main I need important problem? to do? for me to do this?

In nes

The A C C C ACCC is the leading education and advocacy organiation for the cancer care community Founded in 1974 ACCC is a powerful network of 25000 multidisciplinary practitioners from 2100 cancer programs and practices nationwide As advances in cancer screening and diagnosis treatment options and care delivery

models continue to evolveso has ACCCadapting its resources to meet the changing needs of the entire oncology care team For additional strategies to improve patient-provider communication please visit accc-cancerorg/health-literacy unng n suo oe y lly Oncology Ask Me 3 is a registered trademark licensed to the Institute for Healthcare Improvement Used with permission 110 ASSOCIATION OF COMMUNITYThis CANCER video may CENTERS e used as is for educational purposes 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 111

On the CANCER BUZZ podcast, you’ll hear the brightest minds in oncology tackle topics that matter to the multidisciplinary cancer team. • Cancer Team Well-Being • Emergency Medicine • Financial Health Literacy • IO Survivorship • Oncology Pharmacy Catch our • Rural Cancer Care weekly series • Supportive Care Services of mini-podcasts • Symptom Management highlighting • Telehealth critical issues during the • And More! COVID-19 outbreak.

Subscribe on Apple Podcasts, Spotify, or your favorite podcast app!

ACCC-CANCER.ORG/PODCAST2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 111 Quick Reference Guide

Drug Name Brand Name Drug Company Phone number Website Abemaciclib Verzenio® Eli Lilly and Company 1-866-472-8663 www.lillypatientone.com

Abiraterone acetate Yonsa® Sun Oncology 1-855-563-6639 www.yonsarx.com

Abiraterone acetate Zytiga® Janssen Biotech 1-877-227-3728 www.janssencarepath.com

Acalabrutinib Calquence® AstraZeneca 1-844-275-2360 www.myaccess360.com

Ado-trastuzumab emtansine Kadcyla® Genentech 1-866-422-2377 www.genentech-access.com/hcp

Afatinib Gilotrif® Boehringer Ingelheim 1-855-297-5904 boehringer-ingelheim.us/our-responsibility/patient-assistance-program

Alectinib Alecensa® Genentech 1-866-422-2377 www.genentech-access.com/hcp

Alpelisib Piqray® Novartis 1-800-277-2254 www.patient.novartisoncology.com

Apalutamide Erleada® Janssen Biotech 1-877-227-3728 www.janssencarepath.com

Aprepitant Cinvanti® Heron Therapuetics 1-844-437-6611 www.heronconnect.com

Aprepitant Emend® Merck 1-855-257-3932 www.merckaccessprogram.com/hcp/

Arsenic trioxide Trisenox® Teva Oncology 1-888-838-2872 www.tevacares.org

Atezolizumab Tecentriq® Genentech 1-866-422-2377 www.genentech-access.com/hcp

Avelumab Bavencio® EMD Serono/Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Axicabtagene ciloleucel Yescarta® Kite Pharma 1-844-454-5483 www.kitekonnect.com

Axitinib Inlyta® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Azacitidine Vidaza® Celgene 1-800-931-8691 www.celgenepatientsupport.com/other-products/

Azacitidine Onureg® Celgene 1-800-861-0048 www.mybmscases.com/app/login#/

Belantamab mafodotin-blmf Blenrep Bristol Myers Squibb 1-844-447-5662 www.togetherwithgskoncology.com/hcp-resources/

Bendamustine Treanda® Teva Oncology 1-888-838-2872 www.tevacares.org

Bendamustine HCI Bendeka® Teva Oncology 1-888-838-2872 www.tevacares.org

Bevacizumab Avastin® Genentech 1-866-422-2377 www.genentech-access.com/hcp

Bevacizumab-bvzr Zirabev® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Binimetinib Mektovi® Array BioPharma 1-866-277-2927 www.braftovimektovi.com/hcp/financial-support

Blinatumomab Blincyto® Amgen 1-888-427-7478 https://www.amgenassist360.com/hcp/

Bortezomib Velcade® Takeda Oncology 1-866-835-2233 www.velcade.com/paying-for-treatment

Bosutinib Bosulif® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Brentuximab vedotin Adcetris® Seattle Genetics 1-855-473-2873 www.seagensecure.com

Brexucabtagene autoleucel Tecartus™ Kite Pharma 1-844-454-5483 www.kitekonnect.com

Brigatinib Alunbrig® Takeda Oncology 1-844-817-6468 www.takedaoncology1point.com

Cabozantinib Cabometyx® Exelixis 1-844-900-3273 www.activatethecard.com/7311

Capmatinib Tabrecta™ Novartis 1-800-282-7630 www.patient.novartisoncology.com

Carfilzomib Kyprolis® Amgen 1-888-427-7478 www.amgenassist360.com/hcp/

Cemiplimab-rwlc Libtayo® Regeneron/Sanofi 1-877-542-8296 www.libtayohcp.com/accessinglibtayo

Ceritinib Zykadia® Norvartis 1-800-277-2254 www.patient.novartisoncology.com

Cetuximab Erbitux® Eli Lilly and Company 1-866-472-8663 www.lillypatientone.com

Cobimetinib Cotellic® Genentech 1-866-422-2377 www.genentech-access.com/hcp

Copanlisib Aliqopa™ Bayer Healthcare 1-833-254-7672 www.hcp.aliqopa-us.com/access-and-reimbursement/arc-program/

Crizotinib Xalkori® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Dabrafenib Tafinlar® Novartis 1-800-277-2254 https://www.patient.novartisoncology.com

112 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 113 Quick Reference Guide

Drug Name Brand Name Drug Company Phone number Website Abemaciclib Verzenio® Eli Lilly and Company 1-866-472-8663 www.lillypatientone.com

Abiraterone acetate Yonsa® Sun Oncology 1-855-563-6639 www.yonsarx.com

Abiraterone acetate Zytiga® Janssen Biotech 1-877-227-3728 www.janssencarepath.com

Acalabrutinib Calquence® AstraZeneca 1-844-275-2360 www.myaccess360.com

Ado-trastuzumab emtansine Kadcyla® Genentech 1-866-422-2377 www.genentech-access.com/hcp

Afatinib Gilotrif® Boehringer Ingelheim 1-855-297-5904 boehringer-ingelheim.us/our-responsibility/patient-assistance-program

Alectinib Alecensa® Genentech 1-866-422-2377 www.genentech-access.com/hcp

Alpelisib Piqray® Novartis 1-800-277-2254 www.patient.novartisoncology.com

Apalutamide Erleada® Janssen Biotech 1-877-227-3728 www.janssencarepath.com

Aprepitant Cinvanti® Heron Therapuetics 1-844-437-6611 www.heronconnect.com

Aprepitant Emend® Merck 1-855-257-3932 www.merckaccessprogram.com/hcp/

Arsenic trioxide Trisenox® Teva Oncology 1-888-838-2872 www.tevacares.org

Atezolizumab Tecentriq® Genentech 1-866-422-2377 www.genentech-access.com/hcp

Avelumab Bavencio® EMD Serono/Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Axicabtagene ciloleucel Yescarta® Kite Pharma 1-844-454-5483 www.kitekonnect.com

Axitinib Inlyta® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Azacitidine Vidaza® Celgene 1-800-931-8691 www.celgenepatientsupport.com/other-products/

Azacitidine Onureg® Celgene 1-800-861-0048 www.mybmscases.com/app/login#/

Belantamab mafodotin-blmf Blenrep Bristol Myers Squibb 1-844-447-5662 www.togetherwithgskoncology.com/hcp-resources/

Bendamustine Treanda® Teva Oncology 1-888-838-2872 www.tevacares.org

Bendamustine HCI Bendeka® Teva Oncology 1-888-838-2872 www.tevacares.org

Bevacizumab Avastin® Genentech 1-866-422-2377 www.genentech-access.com/hcp

Bevacizumab-bvzr Zirabev® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Binimetinib Mektovi® Array BioPharma 1-866-277-2927 www.braftovimektovi.com/hcp/financial-support

Blinatumomab Blincyto® Amgen 1-888-427-7478 https://www.amgenassist360.com/hcp/

Bortezomib Velcade® Takeda Oncology 1-866-835-2233 www.velcade.com/paying-for-treatment

Bosutinib Bosulif® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Brentuximab vedotin Adcetris® Seattle Genetics 1-855-473-2873 www.seagensecure.com

Brexucabtagene autoleucel Tecartus™ Kite Pharma 1-844-454-5483 www.kitekonnect.com

Brigatinib Alunbrig® Takeda Oncology 1-844-817-6468 www.takedaoncology1point.com

Cabozantinib Cabometyx® Exelixis 1-844-900-3273 www.activatethecard.com/7311

Capmatinib Tabrecta™ Novartis 1-800-282-7630 www.patient.novartisoncology.com

Carfilzomib Kyprolis® Amgen 1-888-427-7478 www.amgenassist360.com/hcp/

Cemiplimab-rwlc Libtayo® Regeneron/Sanofi 1-877-542-8296 www.libtayohcp.com/accessinglibtayo

Ceritinib Zykadia® Norvartis 1-800-277-2254 www.patient.novartisoncology.com

Cetuximab Erbitux® Eli Lilly and Company 1-866-472-8663 www.lillypatientone.com

Cobimetinib Cotellic® Genentech 1-866-422-2377 www.genentech-access.com/hcp

Copanlisib Aliqopa™ Bayer Healthcare 1-833-254-7672 www.hcp.aliqopa-us.com/access-and-reimbursement/arc-program/

Crizotinib Xalkori® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Dabrafenib Tafinlar® Novartis 1-800-277-2254 https://www.patient.novartisoncology.com

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 113 Quick Reference Guide

Drug Name Brand Name Drug Company Phone number Website Dacomitinib Vizimpro® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Daratumumab Darzalex® Janssen Biotech, Inc 1-877-227-3728 www.janssencarepath.com

Darbepoetin alfa Aranesp® Amgen 1-888-427-7478 www.amgenassist360.com/hcp/

Darolutamide Nubeqa® Bayer Healthcare 1-844-682-3723 www.nubeqahcp.com/

Dasatinib Sprycel® Bristol Myers Squibb 1-800-861-0048 www.mybmscases.com/app/login#/

Decitabine and Cedazuridine InqoviI® Taiho Oncology 1-844-824-4648 www.taihopatientsupport.com

Deferasirox Exjade® Novartis 1-800-277-2254 www.patient.novartisoncology.com

Denosumab Prolia® Amgen 1-888-427-7478 www.amgenassist360.com/hcp/

Denosumab Xgeva® Amgen 1-888-427-7478 www.amgenassist360.com/hcp/

Dexrazoxane Zinecard® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Doxorubicin HCI liposome Doxil® Janssen Biotech, Inc 1-877-227-3728 www.janssencarepath.com

Durvalumab Imfinzi® AstraZeneca 1-844-275-2360 www.myaccess360.com

Duvelisib Copiktra® Verastem Oncology 1-833-570-2273 www.copiktra.com/patient-assistance/

Elotuzumab Empliciti® Bristol Myers Squibb 1-800-861-0048 www.mybmscases.com/app/login#/

Eltrombopag Promacta® Novartis 1-800-277-2254 www.patient.novartisoncology.com

Enasidenib Idhifa® Celgene 1-800-931-8691 www.celgenepatientsupport.com

Encorafenib Braftovi® Array BioPharma 1-866-277-2927 www.braftovimektovi.com/financial-support/

Entrectinib Rozlytrek® Genentech 1-866-422-2377 www.genentech-access.com/hcp

Enzalutamide Xtandi® Astellas 1-855-898-2634 www.xtandihcp.com/support-solutions

Epirubicin hydrochloride Ellence® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Epoetin alpha Procrit® Janssen Biotech, Inc 1-877-227-3728 www.janssencarepath.com

Erdafitinib Balversa™ Janssen Biotech, Inc 1-877-227-3728 www.janssencarepath.com

Eribulin mesylate Halaven® Eisai 1-866-613-4724 www.eisaireimbursement.com

Erlotinib Tarceva® Astellas/Genentech 1-866-422-2377 www.genentech-access.com/hcp

Estramustine phosphate sodium Emcyt® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Everolimus Afinitor® Novartis 1-800-277-2254 www.patient.novartisoncology.com

Exemestane Aromasin® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Filgrastim Neupogen® Amgen 1-888-427-7478 www.amgenassist360.com/hcp/

Fosaprepitant Emend® Merck 1-855-257-3932 www.merckhelps.com/EMEND%20FOR%20INJECTION

Fulvestrant Faslodex® AstraZeneca 1-844-275-2360 www.myaccess360.com

Gefitinib Iressa® AstraZeneca 1-844-275-2360 www.myaccess360.com

Gemtuzumab ozogamicin Mylotarg™ Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Gilteritinib Xospata® Astellas Pharma 1-844-632-9272 astellaspharmasupportsolutions.com/products/xospata/index.aspx

Glasdegib Daurismo™ Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Goserelin acetate implant Zoladex® TerSera Therapeutics 1-855-686-8725 www.terserasupportsource.com

Granisetrol Sustol® Heron Therapeutics 1-844-437-6611 www.heronconnect.com

Hyaluronidase-zzxf Phesgo™ Genentech 1-866-422-2377 www.genentech-access.com/hcp

Ibrutinib Imbruvica® Pharmalytics, Inc 1-800-652-6227 www.imbruvicahcp.com/you-i-support/access-support/

Idarubicin hydrochloride Idamycin® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Imatinib mesylate Gleevec® Novartis 1-800-277-2254 www.patient.novartisoncology.com

Inotuzumab ozogamicin Besponsa® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Interferon alfa-2b Intron® A Merck 1-855-257-3932 www.merckhelps.com/INTRON%20%20A

114 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 115 Quick Reference Guide

Drug Name Brand Name Drug Company Phone number Website Dacomitinib Vizimpro® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Daratumumab Darzalex® Janssen Biotech, Inc 1-877-227-3728 www.janssencarepath.com

Darbepoetin alfa Aranesp® Amgen 1-888-427-7478 www.amgenassist360.com/hcp/

Darolutamide Nubeqa® Bayer Healthcare 1-844-682-3723 www.nubeqahcp.com/

Dasatinib Sprycel® Bristol Myers Squibb 1-800-861-0048 www.mybmscases.com/app/login#/

Decitabine and Cedazuridine InqoviI® Taiho Oncology 1-844-824-4648 www.taihopatientsupport.com

Deferasirox Exjade® Novartis 1-800-277-2254 www.patient.novartisoncology.com

Denosumab Prolia® Amgen 1-888-427-7478 www.amgenassist360.com/hcp/

Denosumab Xgeva® Amgen 1-888-427-7478 www.amgenassist360.com/hcp/

Dexrazoxane Zinecard® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Doxorubicin HCI liposome Doxil® Janssen Biotech, Inc 1-877-227-3728 www.janssencarepath.com

Durvalumab Imfinzi® AstraZeneca 1-844-275-2360 www.myaccess360.com

Duvelisib Copiktra® Verastem Oncology 1-833-570-2273 www.copiktra.com/patient-assistance/

Elotuzumab Empliciti® Bristol Myers Squibb 1-800-861-0048 www.mybmscases.com/app/login#/

Eltrombopag Promacta® Novartis 1-800-277-2254 www.patient.novartisoncology.com

Enasidenib Idhifa® Celgene 1-800-931-8691 www.celgenepatientsupport.com

Encorafenib Braftovi® Array BioPharma 1-866-277-2927 www.braftovimektovi.com/financial-support/

Entrectinib Rozlytrek® Genentech 1-866-422-2377 www.genentech-access.com/hcp

Enzalutamide Xtandi® Astellas 1-855-898-2634 www.xtandihcp.com/support-solutions

Epirubicin hydrochloride Ellence® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Epoetin alpha Procrit® Janssen Biotech, Inc 1-877-227-3728 www.janssencarepath.com

Erdafitinib Balversa™ Janssen Biotech, Inc 1-877-227-3728 www.janssencarepath.com

Eribulin mesylate Halaven® Eisai 1-866-613-4724 www.eisaireimbursement.com

Erlotinib Tarceva® Astellas/Genentech 1-866-422-2377 www.genentech-access.com/hcp

Estramustine phosphate sodium Emcyt® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Everolimus Afinitor® Novartis 1-800-277-2254 www.patient.novartisoncology.com

Exemestane Aromasin® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Filgrastim Neupogen® Amgen 1-888-427-7478 www.amgenassist360.com/hcp/

Fosaprepitant Emend® Merck 1-855-257-3932 www.merckhelps.com/EMEND%20FOR%20INJECTION

Fulvestrant Faslodex® AstraZeneca 1-844-275-2360 www.myaccess360.com

Gefitinib Iressa® AstraZeneca 1-844-275-2360 www.myaccess360.com

Gemtuzumab ozogamicin Mylotarg™ Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Gilteritinib Xospata® Astellas Pharma 1-844-632-9272 astellaspharmasupportsolutions.com/products/xospata/index.aspx

Glasdegib Daurismo™ Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Goserelin acetate implant Zoladex® TerSera Therapeutics 1-855-686-8725 www.terserasupportsource.com

Granisetrol Sustol® Heron Therapeutics 1-844-437-6611 www.heronconnect.com

Hyaluronidase-zzxf Phesgo™ Genentech 1-866-422-2377 www.genentech-access.com/hcp

Ibrutinib Imbruvica® Pharmalytics, Inc 1-800-652-6227 www.imbruvicahcp.com/you-i-support/access-support/

Idarubicin hydrochloride Idamycin® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Imatinib mesylate Gleevec® Novartis 1-800-277-2254 www.patient.novartisoncology.com

Inotuzumab ozogamicin Besponsa® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Interferon alfa-2b Intron® A Merck 1-855-257-3932 www.merckhelps.com/INTRON%20%20A

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 115 Quick Reference Guide

Drug Name Brand Name Drug Company Phone number Website Ipilimumab Yervoy® Bristol Myers Squibb 1-800-861-0048 www.mybmscases.com/app/login#/

Irinotecan hydrochloride Camptosar® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Irinotecan liposome Onivyde® Ipsen Biopharmaceutical 1-866-435-5677 www.ipsencares.com

Ixazomib Ninlaro® Takeda Oncology 1-844-817-6468 www.takedaoncology1point.com

Lanreotide Somatuline® Depot Ipsen Pharma 1-866-435-5677 www.ipsencares.com

Lapatinib Tykerb® Novartis 1-800-277-2254 www.patient.novartisoncology.com

Larotrectinib Vitrakvi® Bayer Healthcare 1-877-744-5675 www.hcp.vitrakvi-us.com/access/

Lenalidomide Revlimid® Celegene 1-800-931-8691 www.celgenepatientsupport.com/

Lenvatinib Lenvima® Eisai 1-866-613-4724 www.eisaireimbursement.com

Letrozole Femara® Novartis 1-800-277-2254 www.patient.novartisoncology.com

Leuprolide acetate Lupron Depot® Abbvie www.abbvie.com/patients/patient-assistance.html

Lorlatinib Lorbrena® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Lurbinectedin Zepzelca™ PharmaMar, S.A. 1-833-533-5299 www.zepzelca.com/financial-assistance/

Luspatercept-aamt Reblozyl® Celegene 1-800-931-8691 Ext 4105 www.celgenepatientsupport.com/reblozyl-patient/

Midostaurin Rydapt® Novartis 1-800-277-2254 www.patient.novartisoncology.com

Moxetumomab pasudotox-tdfk Lumoxiti™ Innate Pharma 1-844-694-6628 www.innatecares.com/

Necitumumab Portrazza® Eli Lilly and Company 1-866-472-8663 www.lillypatientone.com

Neratinib Nerlynx® Puma Biotechnology 1-855-816-5421 www.nerlynx.com/access-and-support

Nilotinib Tasigna® Novartis 1-800-277-2254 www.patient.novartisoncology.com

Niraparib Zejulal® GlaxoSmithKline 1-844-447-5662 www.togetherwithgskoncology.com/hcp-resources/

Nivolumab Opdivo® Bristol Myers Squibb 1-800-861-0048 www.mybmscases.com/app/login#/

Obinutuzumab Gazyva® Genentech 1-866-422-2377 www.genentech-access.com/hcp

Octreotide acetate Sandostatin® LAR Depot Novartis 1-800-277-2254 www.patient.novartisoncology.com

Ofatumumab Arzerra® Novartis 1-800-277-2254 www.patient.novartisoncology.com

Olaparib Lynparza® AstraZeneca 1-844-275-2360 www.myaccess360.com

Olaratumab Lartruvo® Eli Lilly and Company 1-866-472-8663 www.lillypatientone.com

Omacetaxine mepesuccinate Synribo® Teva Pharmaceuticals 1-888-838-2872 www.tevacares.org

Osimertinib Tagrisso® AstraZeneca 1-844-275-2360 www.myaccess360.com

Paclitaxel protein-bound particles Abraxane® Celegene 1-800-931-8691 www.celgenepatientsupport.com/

Palbociclib Ibrance® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Palonosetron hydrochloride Aloxi® Eisai 1-866-613-4724 Other patient assistance programs

Panitumumab Vectibix® Amgen 1-888-427-7478 https://www.amgenassist360.com/hcp/

Panobinostat Farydak® Novartis 1-800-277-2254 www.patient.novartisoncology.com

Pegfilgrastim Neulasta® Amgen 1-888-427-7478 https://www.amgenassist360.com/hcp/

Pegfilgrastim Neulasta® Onpro® kit Amgen 1-888-427-7478 www.amgenassist360.com/hcp/

Pegfilgrastim-cbqv Udenyca® Coherus BioSciences 1-844-483-3692 www.coheruscomplete.com/home.html

Pegfilgrastim-jmdb Fulphila® Mylan 1-833-695-2623 www.mylanadvocate.com

Peginterferon alfa-2b Sylatron™ Merck 1-855-257-3932 www.merckhelps.com/SYLATRON

Pembrolizumab Keytruda® Merck 1-855-257-3932 www.merckaccessprogram.com/hcp/

Pemetrexed Alimta® Eli Lilly and Company 1-866-472-8663 www.lillypatientone.com

Pemigatinib Pemazyre® Incyte Corp 1-866-708-8806 hcp.incytecares.com/pemazyre/home.aspx

Pertuzumab Perjeta® Genentech 1-866-422-2377 www.genentech-access.com/hcp

Polatuzumab vedotin Polivy® Genentech 1-866-422-2377 www.genentech-access.com/hcp

116 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 117 Quick Reference Guide

Drug Name Brand Name Drug Company Phone number Website Ipilimumab Yervoy® Bristol Myers Squibb 1-800-861-0048 www.mybmscases.com/app/login#/

Irinotecan hydrochloride Camptosar® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Irinotecan liposome Onivyde® Ipsen Biopharmaceutical 1-866-435-5677 www.ipsencares.com

Ixazomib Ninlaro® Takeda Oncology 1-844-817-6468 www.takedaoncology1point.com

Lanreotide Somatuline® Depot Ipsen Pharma 1-866-435-5677 www.ipsencares.com

Lapatinib Tykerb® Novartis 1-800-277-2254 www.patient.novartisoncology.com

Larotrectinib Vitrakvi® Bayer Healthcare 1-877-744-5675 www.hcp.vitrakvi-us.com/access/

Lenalidomide Revlimid® Celegene 1-800-931-8691 www.celgenepatientsupport.com/

Lenvatinib Lenvima® Eisai 1-866-613-4724 www.eisaireimbursement.com

Letrozole Femara® Novartis 1-800-277-2254 www.patient.novartisoncology.com

Leuprolide acetate Lupron Depot® Abbvie www.abbvie.com/patients/patient-assistance.html

Lorlatinib Lorbrena® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Lurbinectedin Zepzelca™ PharmaMar, S.A. 1-833-533-5299 www.zepzelca.com/financial-assistance/

Luspatercept-aamt Reblozyl® Celegene 1-800-931-8691 Ext 4105 www.celgenepatientsupport.com/reblozyl-patient/

Midostaurin Rydapt® Novartis 1-800-277-2254 www.patient.novartisoncology.com

Moxetumomab pasudotox-tdfk Lumoxiti™ Innate Pharma 1-844-694-6628 www.innatecares.com/

Necitumumab Portrazza® Eli Lilly and Company 1-866-472-8663 www.lillypatientone.com

Neratinib Nerlynx® Puma Biotechnology 1-855-816-5421 www.nerlynx.com/access-and-support

Nilotinib Tasigna® Novartis 1-800-277-2254 www.patient.novartisoncology.com

Niraparib Zejulal® GlaxoSmithKline 1-844-447-5662 www.togetherwithgskoncology.com/hcp-resources/

Nivolumab Opdivo® Bristol Myers Squibb 1-800-861-0048 www.mybmscases.com/app/login#/

Obinutuzumab Gazyva® Genentech 1-866-422-2377 www.genentech-access.com/hcp

Octreotide acetate Sandostatin® LAR Depot Novartis 1-800-277-2254 www.patient.novartisoncology.com

Ofatumumab Arzerra® Novartis 1-800-277-2254 www.patient.novartisoncology.com

Olaparib Lynparza® AstraZeneca 1-844-275-2360 www.myaccess360.com

Olaratumab Lartruvo® Eli Lilly and Company 1-866-472-8663 www.lillypatientone.com

Omacetaxine mepesuccinate Synribo® Teva Pharmaceuticals 1-888-838-2872 www.tevacares.org

Osimertinib Tagrisso® AstraZeneca 1-844-275-2360 www.myaccess360.com

Paclitaxel protein-bound particles Abraxane® Celegene 1-800-931-8691 www.celgenepatientsupport.com/

Palbociclib Ibrance® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Palonosetron hydrochloride Aloxi® Eisai 1-866-613-4724 Other patient assistance programs

Panitumumab Vectibix® Amgen 1-888-427-7478 https://www.amgenassist360.com/hcp/

Panobinostat Farydak® Novartis 1-800-277-2254 www.patient.novartisoncology.com

Pegfilgrastim Neulasta® Amgen 1-888-427-7478 https://www.amgenassist360.com/hcp/

Pegfilgrastim Neulasta® Onpro® kit Amgen 1-888-427-7478 www.amgenassist360.com/hcp/

Pegfilgrastim-cbqv Udenyca® Coherus BioSciences 1-844-483-3692 www.coheruscomplete.com/home.html

Pegfilgrastim-jmdb Fulphila® Mylan 1-833-695-2623 www.mylanadvocate.com

Peginterferon alfa-2b Sylatron™ Merck 1-855-257-3932 www.merckhelps.com/SYLATRON

Pembrolizumab Keytruda® Merck 1-855-257-3932 www.merckaccessprogram.com/hcp/

Pemetrexed Alimta® Eli Lilly and Company 1-866-472-8663 www.lillypatientone.com

Pemigatinib Pemazyre® Incyte Corp 1-866-708-8806 hcp.incytecares.com/pemazyre/home.aspx

Pertuzumab Perjeta® Genentech 1-866-422-2377 www.genentech-access.com/hcp

Polatuzumab vedotin Polivy® Genentech 1-866-422-2377 www.genentech-access.com/hcp

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 117 Quick Reference Guide

Drug Name Brand Name Drug Company Phone number Website Pomalidomide Pomalyst® Celegene 1-800-931-8691 www.celgenepatientsupport.com/

Ponatinib Iclusig® Takeda Oncology 1-844-817-6468 www.takedaoncology1point.com

Radium Ra 223 dichloride Xofigo® Bayer Healthcare 1-855-696-3446 hcp.xofigo-us.com/coordinate-patient-care/getting-patients-started/patient-financial-assistance/

Ramucircumab Cyramza® Eli Lilly and Company 1-866-472-8663 www.lillypatientone.com

Regorafenib Stivarga® Bayer Healthcare 1-866-581-4992 www.stivarga-us.com/getting-and-paying/SPPs/

Ribociclib Kisqali® Novartis 1-800-277-2254 www.patient.novartisoncology.com

Ripretinib Quinlock® Deciphera Pharm 1-833-432-2237 www.decipheraaccesspoint.com/

Rituximab Rituxan® Genentech 1-866-422-2377 www.genentech-access.com/hcp

Rituximab-pvvr Ruxience® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Rituximab and hyaluronidase human Rituxan Hycela® Genentech 1-866-422-2377 www.genentech-access.com/hcp

Rolapitant Varubi® TerSera Therapeutics 1-855-686-8725 www.terserasupportsource.com

Romiplostim Nplate® Amgen 1-888-427-7478 www.amgenassist360.com

Rucaparib Rubraca® Clovis Oncology 1-844-779-7707 www.rubracaconnections.com

Ruxolitinib Jakafi® Incyte 1-855-452-5234 www.incytecares.com

Sacituzumab govitecan-hziy Trodelvy™ Immunomedics 1-844-876-3358 www.trodelvy.com/patient/support

Selpercatinib Retevmo™ Eli Lilly and Company 1-800-545-6962 www.retevmo.com/?section=savings-support

Selumetinib Koselugo™ AstraZeneca 1-844-275-2360 www.myaccess360.com

Sipuleucel-t Provenge® Dendreon 1-877-336-3736 www.provenge.com/reimbursement.aspx

Siltuximab Sylvant® Janssen Biotech, Inc 1-877-227-3728 www.janssencarepath.com

Sonidegib Odomzo® Sun Oncology 1-844-563-6696 www.odomzo.com/hcp/financial-assistance

Sorafenib Nexavar® Bayer Healthcare 1-866-581-4992 hcp.nexavar-us.com/Resources/Patient-Co-Pay-Assistance/

Sunitinib malate Sutent® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Talazoparib Talzenna® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Talimogene laherparepvec Imlygic® Amgen 1-888-427-7478 www.amgenassist360.com

Tafasitamab-cxix Monjuvi® MorphoSys 1-855-421-6172 www.morphosys-us.com/morphosys-foundation

Tbo-filgrastim Granix® Teva Oncology 1-888-838-2872 www.tevacares.org

Temozolomide Temodar® Merck 1-855-257-3932 Other patient assistance programs

Temsirolimus Torisel® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Thalidomide Thalomid® Celegene 1-800-931-8691 www.celgenepatientsupport.com/other-products/

Tisagenlecleucel Kymriah™ Novartis 1-800-277-2254 www.patient.novartisoncology.com

Trabectedin Yondelis® Janssen Biotech, Inc 1-877-227-3728 www.janssencarepath.com

Trametinib Mekinist® Novartis 1-800-277-2254 www.patient.novartisoncology.com

Trastuzumab-anns Kanjinti™ Amgen 1-888-427-7478 www.amgenassist360.com

Trastuzumab-qyyp Trazimera™ Pfizer 1-877-744-5675 Other patient assistance programs

Trastuzumab Herceptin® Genentech 1-866-422-2377 www.genentech-access.com/hcp

Trastuzumab and hyaluronidase-oysk Herceptin Hylecta™ Genentech 1-866-422-2377 www.genentech-access.com/hcp

Trifluridine and tipiracil Lonsurf® Taiho Oncology, Inc 1-844-824-4648 www.taihopatientsupport.com

Tucatinib Tukysa® Seattle Genetics 1-855-473-2873 www.seagensecure.com/patient_tukysa/

Vemurafenib Zelboraf® Genentech 1-866-422-2377 www.genentech-access.com/hcp

Venetoclax Venclexta® Genentech 1-866-422-2377 www.genentech-access.com/hcp

Vismodegib Erivedge® Genentech 1-866-422-2377 www.genentech-access.com/hcp

Vorinostat Zolinza® Merck 1-855-257-3932 www.merckhelps.com/ZOLINZA

118 ASSOCIATION OF COMMUNITY CANCER CENTERS 2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 119 Quick Reference Guide

Drug Name Brand Name Drug Company Phone number Website Pomalidomide Pomalyst® Celegene 1-800-931-8691 www.celgenepatientsupport.com/

Ponatinib Iclusig® Takeda Oncology 1-844-817-6468 www.takedaoncology1point.com

Radium Ra 223 dichloride Xofigo® Bayer Healthcare 1-855-696-3446 hcp.xofigo-us.com/coordinate-patient-care/getting-patients-started/patient-financial-assistance/

Ramucircumab Cyramza® Eli Lilly and Company 1-866-472-8663 www.lillypatientone.com

Regorafenib Stivarga® Bayer Healthcare 1-866-581-4992 www.stivarga-us.com/getting-and-paying/SPPs/

Ribociclib Kisqali® Novartis 1-800-277-2254 www.patient.novartisoncology.com

Ripretinib Quinlock® Deciphera Pharm 1-833-432-2237 www.decipheraaccesspoint.com/

Rituximab Rituxan® Genentech 1-866-422-2377 www.genentech-access.com/hcp

Rituximab-pvvr Ruxience® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Rituximab and hyaluronidase human Rituxan Hycela® Genentech 1-866-422-2377 www.genentech-access.com/hcp

Rolapitant Varubi® TerSera Therapeutics 1-855-686-8725 www.terserasupportsource.com

Romiplostim Nplate® Amgen 1-888-427-7478 www.amgenassist360.com

Rucaparib Rubraca® Clovis Oncology 1-844-779-7707 www.rubracaconnections.com

Ruxolitinib Jakafi® Incyte 1-855-452-5234 www.incytecares.com

Sacituzumab govitecan-hziy Trodelvy™ Immunomedics 1-844-876-3358 www.trodelvy.com/patient/support

Selpercatinib Retevmo™ Eli Lilly and Company 1-800-545-6962 www.retevmo.com/?section=savings-support

Selumetinib Koselugo™ AstraZeneca 1-844-275-2360 www.myaccess360.com

Sipuleucel-t Provenge® Dendreon 1-877-336-3736 www.provenge.com/reimbursement.aspx

Siltuximab Sylvant® Janssen Biotech, Inc 1-877-227-3728 www.janssencarepath.com

Sonidegib Odomzo® Sun Oncology 1-844-563-6696 www.odomzo.com/hcp/financial-assistance

Sorafenib Nexavar® Bayer Healthcare 1-866-581-4992 hcp.nexavar-us.com/Resources/Patient-Co-Pay-Assistance/

Sunitinib malate Sutent® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Talazoparib Talzenna® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Talimogene laherparepvec Imlygic® Amgen 1-888-427-7478 www.amgenassist360.com

Tafasitamab-cxix Monjuvi® MorphoSys 1-855-421-6172 www.morphosys-us.com/morphosys-foundation

Tbo-filgrastim Granix® Teva Oncology 1-888-838-2872 www.tevacares.org

Temozolomide Temodar® Merck 1-855-257-3932 Other patient assistance programs

Temsirolimus Torisel® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

Thalidomide Thalomid® Celegene 1-800-931-8691 www.celgenepatientsupport.com/other-products/

Tisagenlecleucel Kymriah™ Novartis 1-800-277-2254 www.patient.novartisoncology.com

Trabectedin Yondelis® Janssen Biotech, Inc 1-877-227-3728 www.janssencarepath.com

Trametinib Mekinist® Novartis 1-800-277-2254 www.patient.novartisoncology.com

Trastuzumab-anns Kanjinti™ Amgen 1-888-427-7478 www.amgenassist360.com

Trastuzumab-qyyp Trazimera™ Pfizer 1-877-744-5675 Other patient assistance programs

Trastuzumab Herceptin® Genentech 1-866-422-2377 www.genentech-access.com/hcp

Trastuzumab and hyaluronidase-oysk Herceptin Hylecta™ Genentech 1-866-422-2377 www.genentech-access.com/hcp

Trifluridine and tipiracil Lonsurf® Taiho Oncology, Inc 1-844-824-4648 www.taihopatientsupport.com

Tucatinib Tukysa® Seattle Genetics 1-855-473-2873 www.seagensecure.com/patient_tukysa/

Vemurafenib Zelboraf® Genentech 1-866-422-2377 www.genentech-access.com/hcp

Venetoclax Venclexta® Genentech 1-866-422-2377 www.genentech-access.com/hcp

Vismodegib Erivedge® Genentech 1-866-422-2377 www.genentech-access.com/hcp

Vorinostat Zolinza® Merck 1-855-257-3932 www.merckhelps.com/ZOLINZA

2021 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 119 l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l ASSOCIATIONl l l l l l OF l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l COMMUNITY CANCERl l l l l l l l l l CENTERS l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l Approaches to Sharedl l l l l l l l Decision-akingl l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l forl l l l l l thel l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l Oncologyl l l l l l Teaml l l l l l l l l l l l Webinarl l l l l l l l l l l l l l l l Seriesl l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l This si-part weinar seriesl delvesl l l l intol l l variousl l l l l approachesl l l l l l l l forl l engagingl l l l l l l patients l l and their caregivers in shared decision-making

● ● ● ● ● ● ● ● ● ● ● ● ● ● ● C ● ● ● 1● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● C A A ● ● ●2● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●● C C C ● ● ● ● ● ● ● ● ● ● ● ●3● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● C● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● 4● ● ●● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● C ● 5● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● C● ● ● ● ● ● ● 6 ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● A

In nes

The A C C C ACCC is the leading education and advocacy organiation for the cancer care community Founded in 1974 ACCC is a powerful network of 25000 multidisciplinary practitioners from 2100 cancer programs and practices nationwide As advances in cancer screening and diagnosis treatment options and care delivery

models continue to evolveso has ACCCadapting its resources to meet the changing needs of the entire oncology care team For more information visit accc-cancerorg or call 3019849496 Follow us on Faceook LinkedIn Twitter and Instagram read our log ACCCu and tune in to our podcast CANCER U Sponsored by Pfi zer Oncology. l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l Thank You to Our Supporters ASSOCIATIONl l l l l l OF l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l COMMUNITY CANCERl l l l l l l l l l CENTERS l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l Approaches to Sharedl l l l l l l l Decision-akingl l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l forl l l l l l thel l l l l l l l l l l l l l l l l l INDUSTRY ADVISORY COUNCIL l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l Oncologyl l l l l l Teaml l l l l l l l l l l l Webinarl l l l l l l l l l l l l l l l Seriesl l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l This si-part weinar seriesl delvesl l l l intol l l variousl l l l l approachesl l l l l l l l forl l engagingl l l l l l l patients l l and their caregivers in shared decision-making

● ● ● ● ● ● ● ● ● ● ● ● ● ● ● C ● ● ● 1● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● C A A ● ● ●2● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● EMERGING COMPANIES COUNCIL ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●● C C C ● ● ● ● ● ● ● ● ● ● ● ●3● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● C● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● 4● ● ●● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● C ● 5● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● C● ● ● ● ● ● ● 6 ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● A

In nes

TECHNICAL ADVISORY COUNCIL

The A C C C ACCC is the leading education and advocacy organiation for the cancer care community Founded in 1974 ACCC is a powerful network of 25000 multidisciplinary practitioners from 2100 cancer programs and practices nationwide As advances in cancer screening and diagnosis treatment options and care delivery

models continue to evolveso has ACCCadapting its resources to meet the changing needs of the entire oncology care team For more information visit accc-cancerorg or call 3019849496 Follow us on Faceook LinkedIn Twitter and Instagram read our log ACCCu and tune in to our podcast CANCER U Sponsored by Pfi zer Oncology. 1801 Research Boulevard, Suite 400 Rockville, MD 20850 301.984.9496 accc-cancer.org

The Association of Community Cancer Centers (ACCC) is the leading education and advocacy organization for the cancer care community. Founded in 1974, ACCC is a powerful network of 28,000 multidisciplinary practitioners from 2,100 hospitals and practices nationwide. As advances in cancer screening and diagnosis, treat­ment options, and care delivery models continue to evolve—so has ACCC—adapting its resources to meet the changing needs of the entire oncology care team. For more informa- tion, visit accc-cancer.org or call 301.984.9496. Join our social media communities; read our blog, ACCCBuzz; and tune in to our podcast, CANCER BUZZ.

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