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 prescription drug 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 medication. 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 June 1, 2020 and published online in July 2020. 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.

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 1 A Message from ACCC IMMEDIATE PAST PRESIDENT Ali McBride, PharmD, MS, BCOP

ACCC is proud to publish its 9th print edition of the Patient Assistance & Reimbursement Guide for 2020. This guide is a resource that truly reflects my ACCC President’s Theme of “Collaborate. Educate. Compen- sate: A Prescription for Sustainable Cancer Care Delivery.” Ten years ago, nurse navigators, advanced prac- tice providers, financial advocates, and molecular pathologists were not part of the common vernacular describing members of the cancer care team. As oncology engages in value-based reimbursement, new payment models, and precision medicine, oncology pharmacists and pharmacy staff have also become integral members of the cancer care team who help deliver quality, cost-effective care.

While this Patient Assistance & Reimbursement Guide is not a product of the ACCC Financial Advocacy Network—and actually pre-dates this important ACCC initiative—it does align closely with the network’s basic principles. It helps further ACCC’s commitment to continue building the confidence of financial advo- cates and navigators by connecting them with solutions and ultimately improving the patient experience. The guide is a clear product of this commitment by providing the most up-to-date content with accurate links and directions for applying to patient assistance, reimbursement, and/or foundation programs.

Similar to what the ACCC Financial Advocacy Network has done for financial advocates and navigators, the ACCC Oncology Pharmacy Education Network (OPEN) has brought pharmacists and pharmacy staff to the forefront of ACCC membership, highlighting the key role they play in ACCC education and advocacy efforts. OPEN offers pharmacists and other allied and administrative team members the knowledge and know-how to navigate the accelerating course of change in oncology—clinically, operationally, fiscally, and programmatically.

Today, financial navigators and pharmacy staff take part in very specific, yet essential roles that—if effectively integrated—can help reduce financial toxicity and improve patient quality of life. Based on feedback from both of these important member disciplines, we have made updates to the 2020 Patient Assistance & Reimbursement Guide that will improve this resource and help streamline operations and improve the patient and user experience. Specifically, in addition to listing oncology-related medications by both manufacturer (page 2) and brand and generic names (page 3-4), this year we have included a third table of contents that lists medications by oral administration and parenteral administration to better help users find affordable treatment options for patients.

The escalating pace of approval and addition of novel agents mandates continual education and learning. To help in this effort, the ACCC Patient Assistance & Reimbursement Guide is updated on a quarterly basis with the most up-to-date information on cancer drug assistance and reimbursement programs, including directions on how to apply and links to enrollment forms. And you can help! As you use this guide throughout the year, if you know of any changes, updates, and/or corrections to the information within, please let us know. We also want to hear your feedback on how you are using this guide and if you have ideas for how we can improve this critical resource. Please direct all comments, questions, and feedback to Maddelynne Parker, Content Coordinator, at [email protected].

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 1 ASSOCIATION OF COMMUNITY CANCER CENTERS

1 A Message From ACCC President by Dr. Ali McBride

7 Financial Advocacy Network Pre-Conference: Top Takeaways by Clara Lambert & Lori Schneider

10 Patient Assistance Program Flowchart

Pharmaceutical Company Patient Medical Device & Testing Patient Assistance & Reimbursement Programs Assistance & Reimbursement Programs AbbVie, Inc. 13 Adaptive Biotechnologies 81 Amgen, Inc. 14 Foundation Medicine 82 Astellas Pharma U.S., Inc. 16 AstraZeneca 19 Other Patient Assistance Programs & Resources Bayer HealthCare Pharmaceuticals, Inc. 21 Agingcare.com® 89 BeiGene 25 AuntBertha.com 89 Blueprint Medicines 26 BenefitsCheckUp® 89 Bristol Myers Squibb 28 Celgene Oncology 30 CancerCare® 89 Coherus BioSciences 32 Cancer Financial Assistance Coalition 90 Eisai Co., Ltd. 34 Co-Pay Relief 90 Eli Lilly and Company 36 FamilyWize® 91 EMD Serono, Inc. 38 Good Days® 91 Exelixis, Inc. 40 HealthWell Foundation® 91 Genentech, Inc. 41 The Leukemia & Lymphoma Society 92 GlaxoSmithKline 43 Medicine Assistance Tool 92 Incyte Corporation 45 NeedyMeds 93 Ipsen Biopharmaceuticals, Inc. 47 Patient Access Network Foundation 94 Janssen Biotech, Inc. 49 Patient Advocate Foundation 94 Karyopharm Therapeutics 51 RxVantage 95 Kite Pharma 53 RxHope™ 95 Merck 54 Mylan 56 Rx Outreach® 96 Novartis Pharmaceuticals Corporation 58 Pfizer, Inc. 60 Quick Reference Guide 98 Pharmacyclics, LLC 62 Regeneron Pharmaceuticals, Inc. and Sanofi Genzyme 64 Sandoz 66 Sanofi Genzyme 68 Seattle Genetics 70 Sun Pharmaceutical Industries, Inc. 71 Taiho Oncology 73 The ACCC Patient Assistance & Reimbursement Guide was printed in January 2020. This publication is updated four times Takeda Oncology 75 a year. Visit accc-cancer.org/PatientAssistanceGuide to TerSera Therapeutics 77 download and print the most up-to-date information on cancer Teva Oncology 78 drug assistance and reimbursement programs.

2 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 3 Patient Assistance & Reimbursement Assistance Programs by drug or product

Abraxane® (paclitaxel protein-bound particles Gazyva® (obinutuzumab) injection 41 for injectable suspension) (albumin-bound) 30 Gleevec® (imatinib mesylate) tablets 58 Adakveo® (crizanlizumab-tmca) for IV infusion 58 Granix® (tbo-filgrastim) for injection 78 Adcetris® (brentuximab vedotin) for injection 70 Halaven® (eribulin mesylate) injection 34 Afinitor® (everolimus) tablets 58 Herceptin® (trastuzumab) 41 Alecensa® (alectinib) capsules 41 Herceptin Hylecta™ (trastuzumab and Alimta® (pemetrexed) for injection 36 hyaluronidase-oysk) 41 Aliqopa™ (copanlisib) for injection 21 Ibrance® (palbociclib) capsules 60 Alunbrig® (brigatinib) 75 Iclusig® (ponatinib) tablets 75 Aranesp® (darbepoetin alfa) injection 14 Idamycin PFS® (idarubicin hydrochloride) Aromasin® (exemestane) tablets 60 for injection 60 Avastin® (bevacizumab) injection 41 Idhifa® (enasidenib) 30 Ayvakit™ (avapritinib) tablets 26 Imbruvica® (ibrutinib) capsules 62 Balversa™ (erdafitinib) tablets 49 Imfinzi® (durvalumab) injection 19 Bavencio® (avelumab) injection 38 Imlygic® (talimogene laherparepvec) suspension for injection 14 Bendeka® (bendamustine hydrochloride) for injection 78 Inlyta® (axitinib) tablets 60 Besponsa® (inotuzumab ozogamicin) for injection 60 Intron® A (interferon alfa-2b, recombinant) for injection 54 Blincyto® (blinatumomab) for injection 14 Iressa® (gefitinib) 19 Bosulif® (bosutinib) tablets 60 Istodax® (romidepsin) for injection 30 Brukinsa™ (Zanubrutinib) capsules 25 Jadenu® (deferasirox) 58 Cabometyx® (cabozantinib) tablets 40 Jakafi® (ruxolitinib) tablets 45 Calquence® (acalabrutinib) capsules 19 Jevtana® (cabazitaxel) injection 68 Camptosar® (irinotecan hydrochloride) injection 60 Kadcyla® (ado-trastuzumab emtansine) 41 Cometriq® (cabozantinib) capsules 40 Kanjinti™ (trastuzumab-anns) for injection 14 Cotellic® (cobimetinib) tablets 41 Keytruda® (pembrolizumab) injection 54 Cyramza® (ramucirumab) injection 36 Kisqali® (ribociclib) tablets 58 Darzalex® (daratumumab) injection 49

™ Kymriah® (tisagenlecleucel) suspension Darzalex Faspro (daratumumab and hyaluronidase-fihj) for IV infusion 58 injection 49 Kyprolis® (carfilzomib) for injection 14 Daurismo™ (glasdegib) tablets 60 Lenvima® (lenvatinib) capsules 34 Elitek® (rasburicase) IV infusion 68 Libtayo® (cemiplimab-rwlc) injection 64 Ellence® (epirubicin hydrochloride injection) 60 Lonsurf® (trifluridine and tipiracil) tablets 73 Emend® (aprepitant) 54 Lorbrena® (lorlatinib) 60 Emend® (fosaprepitant) for injection 54 Lumoxiti™ (moxetumomab pasudotox-tdfk) Empliciti® (elotuzumab) for injection 28 for injection 19 Erbitux® (cetuximab) injection 36 Lupron Depot® (leuprolide acetate for depot Erleada® (apalutamide) tablets 49 suspension) 13 Erivedge® (vismodegib) capsules 41 Lynparza® (olaparib) 19 Exjade® (deferasirox) tablets 58 Mekinist® (trametinib) tablets 58 Faslodex® (fulvestrant) injection 19 Mylotarg™ (gemtuzumab ozogamicin) for injection 60 Femara® (letrozole) tablets 58 Neulasta® (pegfilgrastim) injection 14 Fulphila® (pegfilgrastim-jmdb) injection 56 Neulasta® Onpro® (pegfilgrastim) injection kit 14 Gardasil®9 (Human Papillomavirus 9-valent Vaccine, Recombinant) 54 Neupogen® (filgrastim) 14

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 3 Patient Assistance & Reimbursement Assistance Programs by drug or product (continued)

Nexavar® (sorafenib) tablets 21 Tecentriq® (atezolizumab) for injection 41 Ninlaro® (ixazomib) capsules 75 Thalomid® (thalidomide) capsules 30 Nivestym™ (filgrastim-aafi) injection 60 Torisel® (temsirolimus) injection 60 Nplate® (romiplostim) injection 14 Trazimera™ (trastuzumab-qyyp) injection 60 Nubeqa® (darolutamide) tablets 21 Treanda® (bendamustine hydrochloride) for injection 78 Odomzo® (sonidegib) capsules 71 Trisenox® (arsenic trioxide) injection 78 Ogivri™ (trastuzumab-dkst) injection 56 Tukysa™ (tucatinib) tablets 70 Onivyde® (irinotecan liposome injection) 47 Tykerb® (lapatinib) tablets 58 Opdivo® (nivolumab) injection 28 Udenyca® (pegfilgrastim-cbqv) 32 Padcev™ (enfortumab vedotin-ejifv) injection 16 Varubi® (rolapitant) tablets 77 Perjeta® (pertuzumab) for injection 41 Vectibix® (panitumumab) for injection 14 Pemazyre™ (pemigatinib) tablets 45 Velcade® (bortezomib) for injection 75 Piqray® (alpelisib) tablets 58 Venclexta® (venetoclax) tablets 41 Polivy™ (polatuzumab vedotin-piiq) injection 41 Verzenio® (abemaciclib) tablets 36 Pomalyst® (pomalidomide) capsules 31 Vidaza® (azacitidine for injection) 30 Portrazza® (necitumumab) injection 36 Vitrakvi® (larotrectinib) 21 Procrit® (epoetin alfa) 49 Vizimpro® (dacomitinib) tablets 60 Prolia® (denosumab) injection 14 Votrient® (pazopanib) tablets 58 Promacta® (eltrombopag) tablets 58 Xalkori® (crizotinib) capsules 60 Reblozyl® (luspatercept-aamt) for injection 30 Xgeva® (denosumab) injection 14 Retevmo™ (selpercatinib) capsules 36 Xofigo® (radium Ra 223 dichloride) injection 21 Revlimid® (lenalidomide) capsules 30 Xospata® (gilteritinib) tablets 16 Rituxan® (rituximab) 41 Xpovio® (selinexor) tablets 51 Rituxan Hycela® (rituximab/hyaluronidase human) Xtandi® (enzalutamide) capsules 16 for injection 41 Yervoy® (ipilimumab) 28 Rozlytrek™ (entrectinib) 41 Yescarta® (axicabtagene ciloleucel) suspension Ruxience™ (rituximab-pvvr) 60 for infusion 53 Rydapt® (midostaurin) 58 Yondelis® (trabectedin) 49 Sandostatin® (octreotide acetate) for injection 58 Yonsa® (abiraterone acetate) tablets 71 Sandostatin® LAR Depot (octreotide acetate) Zarxio® (filgrastim-sndz) subcutaneous or intravenous for injectable suspension 58 injection 66 Sarclisa® (isatuximab-irfc) injection for IV use 68 Ziextenzo® (pegfilgrastim) injection 66 Sensipar® (cinacalcet) tablets 14 Zejula® (niraparib) capsules 43 Somatuline® Depot (lanreotide) for injection 47 Zelboraf® (vemurafenib) tablets 41 Sprycel® (dasatinib) tablets 28 Zinecard® (dexrazoxane) for injection 60 Stivarga® (regorafenib) tablets 21 Zirabev™ (bevacizumab-qyyp) injection 60 Sutent® (sunitinib malate) capsules 60 Zoladex® (goserelin acetate implant) 78 Sylatron™ (peginterferon alfa-2b) for injection 55 Zolinza® (vorinostat) 55 Synribo® (omacetaxine mepesuccinate) Zometa® (zoledronic acid) for injection 58 for injection 78 Zykadia® (ceritinib) tablets 58 Tabrecta™ (capmatinib) tablets 58 Zytiga® (abiraterone acetate) tablets 49 Tafinlar® (dabrafenib) capsules 58 Tagrisso® (osimertinib) tablets 58 Talzenna™ (talazoparib) capsules 60 Tarceva® (erlotinib) tablets 41 Tasigna® (nilotinib) capsules 58

4 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 5 Patient Assistance & Reimbursement Assistance Programs by parenteral administration and oral administration

Parenteral Administration Kyprolis® (carfilzomib) for injection 14 Abraxane® (paclitaxel protein-bound particles Libtayo® (cemiplimab-rwlc) injection 64 for injectable suspension) (albumin-bound) 30 Lumoxiti™ (moxetumomab pasudotox-tdfk) Adakveo® (crizanlizumab-tmca) for IV infusion 58 for injection 19 Adcetris® (brentuximab vedotin) for injection 70 Lupron Depot® (leuprolide acetate for depot suspension) 13 Alimta® (pemetrexed) for injection 36 Mylotarg™ (gemtuzumab ozogamicin) ™ Aliqopa (copanlisib) for injection 21 for injection 60 Aranesp® (darbepoetin alfa) injection 14 Neulasta® (pegfilgrastim) injection 14 Avastin® (bevacizumab) injection 41 Neulasta® Onpro® (pegfilgrastim) injection kit 14 Bavencio® (avelumab) injection 38 Neupogen® (filgrastim) 14 Bendeka® (bendamustine hydrochloride) Nivestym™ (filgrastim-aafi) injection 60 for injection 78 Nplate® (romiplostim) injection 14 Besponsa® (inotuzumab ozogamicin) for injection 60 Ogivri™ (trastuzumab-dkst) injection 56 Blincyto® (blinatumomab) for injection 14 Onivyde® (irinotecan liposome injection) 47 Camptosar® (irinotecan hydrochloride) injection 60 Opdivo® (nivolumab) injection 28 Cyramza® (ramucirumab) injection 36 Padcev™ (enfortumab vedotin-ejifv) injection 16 Darzalex® (daratumumab) injection 49 Perjeta® (pertuzumab) for injection 41 Darzalex Faspro™ (daratumumab and hyaluronidase-fihj) ™ injection 49 Polivy (polatuzumab vedotin-piiq) injection 41 Elitek® (rasburicase) IV infusion 68 Portrazza® (necitumumab) injection 36 Ellence® (epirubicin hydrochloride injection) 60 Procrit® (epoetin alfa) 49 Emend® (fosaprepitant) for injection 54 Prolia® (denosumab) injection 14 Empliciti® (elotuzumab) for injection 28 Reblozyl® (luspatercept-aamt) for injection 30 Erbitux® (cetuximab) injection 36 Rituxan® (rituximab) 41 Faslodex® (fulvestrant) injection 19 Rituxan Hycela® (rituximab/hyaluronidase human) for injection 41 Fulphila® (pegfilgrastim-jmdb) injection 56 Reblozyl® (luspatercept-aamt) for injection 31

Gardasil®9 (Human Papillomavirus 9-valent ™ Vaccine, Recombinant) 54 Ruxience (rituximab-pvvr) 60 Gazyva® (obinutuzumab) injection 41 Sarclisa® (isatuximab-irfc) injection for IV use 68 Granix® (tbo-filgrastim) for injection 78 Sandostatin® (octreotide acetate) for injection 58 Halaven® (eribulin mesylate) injection 34 Sandostatin® LAR Depot (octreotide acetate) for injectable suspension 58 Herceptin® (trastuzumab) 41 Somatuline® Depot (lanreotide) for injection 47 ™ Herceptin Hylecta (trastuzumab and ™ hyaluronidase-oysk) 41 Sylatron (peginterferon alfa-2b) for injection 54 Idamycin PFS® (idarubicin hydrochloride) Synribo® (omacetaxine mepesuccinate) for injection 78 for injection 60 Tecentriq® (atezolizumab) for injection 41 Imfinzi® (durvalumab) injection 19 Torisel® (temsirolimus) injection 60 Imlygic® (talimogene laherparepvec) suspension for injection 14 Trazimera™ (trastuzumab-qyyp) injection 60 Intron® A (interferon alfa-2b, recombinant) Treanda® (bendamustine hydrochloride) for injection 78 for injection 54 Trisenox® (arsenic trioxide) injection 78 Istodax® (romidepsin) for injection 30 Udenyca® (pegfilgrastim-cbqv) 32 Jevtana® (cabazitaxel) injection 68 Vectibix® (panitumumab) for injection 14 Kadcyla® (ado-trastuzumab emtansine) 41 Velcade® (bortezomib) for injection 75 Kanjinti™ (trastuzumab-anns) for injection 14 Vidaza® (azacitidine for injection) 30 Keytruda® (pembrolizumab) injection 54 Xgeva® (denosumab) injection 14 Kymriah® (tisagenlecleucel) suspension Xofigo® (radium Ra 223 dichloride) injection 21 for IV infusion 58

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 5 Patient Assistance & Reimbursement Assistance Programs by parenteral administration and oral administration (continued)

Yervoy® (ipilimumab) 28 Mekinist® (trametinib) tablets 58 Yescarta® (axicabtagene ciloleucel) suspension Nexavar® (sorafenib) tablets 21 for infusion 53 Ninlaro® (ixazomib) capsules 75 Yondelis® (trabectedin) 49 Nubeqa® (darolutamide) tablets 21 Zarxio ®(filgrastim-sndz) subcutaneous or intravenous Odomzo® (sonidegib) capsules 71 injection 66 Pemazyre™ (pemigatinib) tablets 45 Ziextenzo®(pegfilgrastim) injection 66 Piqray® (alpelisib) tablets 58 Zinecard® (dexrazoxane) for injection 60 Pomalyst® (pomalidomide) capsules 30 Zirabev™ (bevacizumab-bvzr) injection 60 Promacta® (eltrombopag) tablets 58 Zoladex® (goserelin acetate implant) 77 Retevmo™ (selpercatinib) capsules 36 Zometa® (zoledronic acid) for injection 58 Revlimid® (lenalidomide) capsules 31 Oral Administration Rozlytrek™ (entrectinib) 41 Afinitor® (everolimus) tablets 58 Rydapt® (midostaurin) 58 Alecensa® (alectinib) capsules 41 Sensipar® (cinacalcet) tablets 14 Alunbrig® (brigatinib) 75 Sprycel® (dasatinib) tablets 28 Aromasin® (exemestane) tablets 60 Stivarga® (regorafenib) tablets 21 ™ Ayvakit (avapritinib) tablets 27 Sutent® (sunitinib malate) capsules 60 ™ Balversa (erdafitinib) tablets 49 Tabrecta™ (capmatinib) tablets 58 Bosulif® (bosutinib) tablets 60 Tafinlar® (dabrafenib) capsules 58 ™ Brukinsa (Zanubrutinib) capsules 25 Tagrisso® (osimertinib) tablets 19 Cabometyx® (cabozantinib) tablets 40 Talzenna™ (talazoparib) capsules 60 Calquence® (acalabrutinib) capsules 19 Tarceva® (erlotinib) tablets 41 Cometriq® (cabozantinib) capsules 40 Tasigna® (nilotinib) capsules 58 Cotellic® (cobimetinib) tablets 41 Thalomid® (thalidomide) capsules 31 ™ Daurismo (glasdegib) tablets 60 Tukysa™ (tucatinib) tablets 70 Emend® (aprepitant) 54 Tykerb® (lapatinib) tablets 58 Erleada® (apalutamide) tablets 49 Varubi® (rolapitant) tablets 77 Erivedge® (vismodegib) capsules 41 Venclexta® (venetoclax) tablets 41 Exjade® (deferasirox) tablets 58 Verzenio® (abemaciclib) tablets 36 Femara® (letrozole) tablets 58 Vitrakvi® (larotrectinib) 21 Gleevec® (imatinib mesylate) tablets 58 Vizimpro® (dacomitinib) tablets 60 Ibrance® (palbociclib) capsules 60 Votrient® (pazopanib) tablets 58 Iclusig® (ponatinib) tablets 75 Xalkori® (crizotinib) capsules 60 Idhifa® (enasidenib) 30 Xospata® (gilteritinib) tablets 17 Inrebic® (fedratinib) capsules 30 Xpovio® (selinexor) tablets 51 Imbruvica® (ibrutinib) capsules 62 Xtandi® (enzalutamide) capsules 16 Inlyta® (axitinib) tablets 60 Yonsa® (abiraterone acetate) tablets 71 Iressa® (gefitinib) 19 Zejula® (niraparib) capsules 43 Jadenu® (deferasirox) 58 Zelboraf® (vemurafenib) tablets 41 Jakafi® (ruxolitinib) tablets 45 Zolinza® (vorinostat) 54 Kisqali® (ribociclib) tablets 58 Zykadia® (ceritinib) tablets 58 Lenvima® (lenvatinib) capsules 34 Zytiga® (abiraterone acetate) tablets 49 Lonsurf® (trifluridine and tipiracil) tablets 73 Lorbrena® (lorlatinib) 60 Lynparza® (olaparib) 19

6 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 7 ASSOCIATION OF COMMUNITY CANCER CENTERS

FINANCIAL ADVOCACY NETWORK

ACCC 2019 FINANCIAL ADVOCACY NETWORK PRE-CONFERENCE TOP TAKEAWAYS

ore than 100 financial navigators, cancer program leaders, and other members of the multi- disciplinary cancer care team attended this Pre-Conference on Wednesday, October 30, held Mduring the ACCC 36th National Oncology Conference in Orlando, Fla. Through live polling, attendees were able to submit questions and comments in sessions throughout the day. Members of the ACCC Financial Advocacy Network Advisory Committee then answered these questions in a robust Town Hall session where attendees also brought their own concerns and ideas to the table. Below Advisory Committee Chair Clara Lambert, BBA, OPN-CG, an oncology financial navigator at Advocate Good Samaritan Bhorade Cancer Center, and Committee Member Lori Schneider, busi- ness office manager at Green Bay Oncology, share their top five takeaways from the Pre-Conference.

Clara Lambert’s Top Five Takeaways ACCC Financial Advocacy Network Advisory Committee Chair 2018 - 2019

I was honored to facilitate this Pre-Conference with my fellow Advisory Committee Member, Lori Schneider. We had a full day of engaging conversations, and it was very exciting to have speakers from different organizations come together to share the innovations and strategies that have made them successful in financial naviga- tion. My top takeaways from the day are:

1. There exists a continuing interest and quest for additional knowledge in financial navigation. Although ACCC has covered this topic in various meeting sessions for the past five years, members place value in a Pre-Conference devoted exclusively to this content.

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 7 2. Cancer programs continue to have a need for 4. Technological tools are evolving and can be a big resources to support the growth of this service help to financial navigation programs. A wide variety line. ACCC released its newest tool, “Making of technology tools and vendors are stepping up to the Business Case for Hiring a Financial facilitate financial navigation, specifically identifying Navigator,” authored by Lori Schneider and ways to help with financial navigation workload and Christina Fuller, to great fanfare. I am hoping prioritization. Non-profit organizations are contrib- over the next two years to see hospitals and uting with their own tools and ideas. practices putting the business case study 5. As a field, financial navigation continues to into play by adding financial navigation to innovate to better meet our patients’ needs. their list of services. Access it online at accc- A common theme throughout the Pre-Conference cancer.org/docs/projects/financial-advocacy/ was our quest to help cancer patients and support ufo-2019-fan-navigator-tool.pdf. the financial health of our cancer programs. The energy and engagement from speakers and the 3. ACCC members are asking for financial audience was invigorating and revitalizing. navigation certification. This is a complicated endeavor, but I would love if ACCC can find I always say one of the best tools a financial navigator a way to move this idea forward. In the past can have is a network of colleagues who share their two years, as chair of the Financial Advocacy passion. This Pre-Conference afforded an excellent Network, I have often been asked if there is networking opportunity. going to be a certification for financial navigation—beyond the existing Boot Camp.

Lori Schneider’s Top Five Takeaways ACCC Financial Advocacy Network Advisory Committee Chair 2020 I was honored to help plan this hugely successful Pre-Conference. We featured speakers from health systems that have had financial navigation programs for more than 10 years, as well as those that are just now developing programs. While many valuable tips and tools were shared, my top five takeaways from the day included:

1. Financial toxicity continues to be a rising 2. Financial navigators need more tools and resources concern for patients and their families. Many to help optimize their programs. Live polling allowed of the day’s speakers gave examples of what attendees to ask questions that were then reviewed they are doing to help fight financial toxicity. and answered at the end of each presentation. Finan- Some included data points showing that even cial navigators were shown a wide variety tools—both patients with insurance or those who receive commercial (proprietary) and homegrown solutions. co-pay assistance still face significant financial For example, Advisory Committee Member, Angie concerns. Out-of-pocket costs and insurance Santiago, CRCS-I, Thomas Jefferson University Health premiums continue to be a financial burden, System, Sidney Kimmel Cancer Center, presented especially when added to current household spreadsheets and tools that she created to help bills and a reduction of income due to an with tracking and productivity, as well as a tool that inability to work. Insurance optimization and is used to help patients compare insurance plans. coverage—along with foundation and patient The latter allows patients to choose a plan that best assistance programs—are key factors to meets their individual and family needs. helping patients and families.

8 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 9 3. There is an identified need for data and metrics 5. Financial navigation programs are not a reporting. Attendees received an overview of the one-size-fits-all. Throughout the day, speakers ACCC Financial Advocacy Boot Camp module demonstrated that health systems create financial “Measuring and Reporting,” which showcased the navigation programs that are tailor made to fit their importance of measuring and tracking patient organization. For example, Vanderbilt-Ingram data. Recommended items to track included Medi- Cancer Center highlighted its optimization project care-only patients, uninsured patients, patients who that resulted from one of the ACCC’s Financial are receiving co-pay and/or foundation assistance, Advocacy Learning Labs. Access online at: accc- and patients that are receiving medication from cancer.org/FANLearningLabs. More, financial pharmaceutical patient assistance programs. It is also navigation programs originate out of a variety of important to track the number of patients each navi- departments in a cancer center, including pharmacy, gator works with and how much time is spent with social work, or revenue cycle/billing. Finally, there patients in order to determine an average. These is also a variety of focus points across the financial data can then be presented to management to help navigation landscape due to how these programs determine staffing needs. grow within the healthcare system. Focus areas for these programs include insurance optimization, 4. Networking and learning from others are key foundation and/or co-pay assistance, pharmaceutical because of the ever-changing landscape of patient assistance for oral and/or IV medications, and financial navigation. There is always something new the completion of authorizations, as well as programs to learn by networking with our peers—whether it be that include a mix of these. processes, tools, or resources. With the landscape of oncology constantly changing, it is difficult to stay The knowledge shared, friendships made, and on top of all updates. Attendees agreed that the follow-up conversations that continued throughout the ACCC Financial Advocacy Boot Camp is one of the conference were a highlight of this Pre-Conference. I best training tools for financial navigators. Another know that together we can all help make a difference in important resource: the ACCC Financial Advocacy the fight against financial toxicity. Network Guidelines. Our Pre-Conference ended with an ACCC Financial Advocacy Town Hall where subject matter experts and attendees benefited alike from an engaged Q&A and brainstorming session.

The ACCC Financial Advocacy Network is supported by:

Gold Partners Cornerstone Partner

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. Join our social media communities; 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.

© 2020. Association of Community Cancer Centers. All rights reserved. No part of this publication may be reproduced or trans­mitted in any form or by any means without written permission.

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 9 Flowchart

STEP 1. Provider writes chemotherapy order for patient. STEP 2. Chemotherapy order is sent to finance staff. STEP 3. Staff identifies the patient’s financial status and follows the appropriate flowchart below.

Identify if patient qua- Fill out forms for all Identify if foundation funding Fill out forms for lifies for any programs programs. Complete forms is available for any drugs not foundation funding No Insurance (SSDI, Medicaid, etc.). for companies that have a replaced. that is available. Identify if replacement replacement program drugs are available. if patient qualifies.

Verify benefits. Verify drugs are Identify if replacement Identify patient’s indicated for diagnosis drugs are available if responsibility. Medicaid and authorize if necessary; will need to Program necessary. appeal to receive drugs.

Verify benefits. Verify drugs are Identify if replacement Identify patient’s indicated for diagnosis. drugs are available if responsibility. Medicare necessary; will need to Only appeal to receive drugs.

Verify benefits. Verify drugs are Identify if replacement Identify patient’s indicated for diagnosis. drugs are available if responsibility; if Medicare & necessary; will need to none, start treatment. Supplemental appeal to receive drugs.

Verify benefits. Verify drugs are Identify if replacement Identify patient’s indicated for diagnosis drugs are available if responsibility. Medicare & and authorize secondary necessary; will need to Secondary insurance if necessary. appeal to receive drugs.

Verify benefits. Verify drugs are Identify if replacement Identify patient’s Medicare indicated for diagnosis drugs are available if responsibility. Advantage and authorize secondary necessary; will need to insurance if necessary. appeal to receive drugs.

Verify benefits. Verify drugs are Identify if replacement Identify patient’s indicated for diagnosis drugs are available if responsibility. Other and authorize secondary necessary; will need to Government insurance if necessary. appeal to receive drugs. Programs

Verify benefits. Verify drugs are Identify if replacement Identify patient’s indicated for diagnosis drugs are available if responsibility. and authorize secondary necessary; will need to Managed Care insurance if necessary. appeal to receive drugs.

Verify benefits. Verify drugs are Identify if replacement Identify patient’s indicated for diagnosis drugs are available if responsibility. Commercial & and authorize secondary necessary; will need to Insurance insurance if necessary. appeal to receive drugs. Exchanges

10 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 11 Flowchart

Identify if patient Create payment qualifies for charity plan for any balance care within the clinic (if available) or or institution and collect balance. complete paperwork.

Collect out-of-pocket costs.

Identify if foundation Fill out forms for Identify if patient Create payment assistance is available. foundation funding qualifies for charity plan for any balance that is available. care within the clinic (if available) or or institution and collect balance. complete paperwork.

If patient has Fill out forms for If patient qualifies, If any balance, responsibility, foundation funding send in EOB and/or create payment identify if foundation that is available. anything else to help plan for any balance assistance is available. verify amount for (if available) or foundation to pay. collect balance.

Identify if foundation Fill out forms for If patient qualifies, If any balance, assistance is available. foundation funding send in EOB and/or create payment that is available. anything else to help plan for any balance verify amount for (if available) or foundation to pay. collect balance.

Identify if foundation Fill out forms for If patient qualifies, If any balance, assistance is available. foundation funding send in EOB and/ create payment that is available. or anything else to plan for any balance help verify amount for (if available) or foundation to pay. collect balance.

Identify if foundation Fill out forms for If patient qualifies, If any balance, assistance is available. foundation funding send in EOB and/or create payment that is available. anything else to help plan for any balance verify amount for (if available) or foundation to pay. collect balance.

Identify if manu- If no manufacturer Fill out forms for If patient qualifies for Process payment If any balance, facturer assistance assistance, then foundation funding manufacturer or using co-pay card create payment is available and fill identify if foundation that is available. foundation assistance, or whatever form plan (if available) out forms if applicable. assistance is available. send in EOB and/or of payment the or collect anything else to help program has. balance from verify amount owed. patient.

Identify if manu- If no manufacturer Fill out forms for If patient qualifies for Process payment If any balance, facturer assistance assistance, then foundation funding manufacturer or using co-pay card create payment is available and fill identify if foundation that is available. foundation assistance, or whatever form plan (if available) out forms if applicable. assistance is available. send in EOB and/or of payment the or collect anything else to help program has. balance from verify amount owed. patient.

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 11 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 submit a program application. Download the application (abbvie. myAbbVie Assist com/content/dam/abbvie-dotcom/ Patient Assistance uploads/PDFs/pap/Lupron-Appli- MyAbbVie Assist believes that cation-approved.pdf), follow the people who need AbbVie medicines instructions on the first page, and should be able to get them. submit all requested information via MyAbbVie Assist provides free fax to 1.866.483.1305. For more medicines to qualifying patients. information, call 1.800.222.6885, Financial need requirements vary Monday through Friday. by medicine, and are based on your insurance coverage, household This program is part of the AbbVie income, and projected out-of-pocket Patient Assistance Foundation, a medical expenses. Patients may separate legal entity from AbbVie. be eligible to receive free Lupron Depot if they: REIMBURSEMENT • Have been prescribed Lupron ASSISTANCE Depot • Have limited or no health Lupron Depot insurance coverage Support Plus • Live in the United States With Support Plus, providers will • Are being treated by a licensed receive: U.S. health care provider on an • Patient benefit investigations outpatient basis • Precertification and prior authorization management If patients have insurance, the • Reimbursement support program will review their qualifying • Claims appeal assistance. financial need based on a combination of insurance coverage, household Whether it’s Medicare Advantage income, and out-of-pocket medical or private insurance, Lupron Depot expenses. MyAbbVie Assist will Support Plus supports providers and evaluate patients’ insurance coverage their office by helping to manage and out-of-pocket medical expenses the procurement process. Contact during the application process. your AbbVie Sales Representative to learn more about how to access If patients apply, they should work the Support Plus Program or call with their healthcare provider to 1.800.621.1020.

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 13 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, Neulasta® (pegfilgrastim) injection, Neulasta® Onpro® (pegfilgrastim) injection kit, Neupogen® (filgrastim), 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

• Help patients get the answers they • Patients must not participate PATIENT ASSISTANCE need if they have questions about in any federal, state, or govern- Amgen Assist 360™ their Amgen medication. ment-funded healthcare program, Amgen Assist 360 is a single such as Medicare, Medicare place for patients, caregivers, and For more information and Advantage, Medicare Part D, healthcare professionals to go to find enrollment forms by specific drugs, Medicaid, Medigap, Veterans the support, tools, and resources visit https://www.amgenassist360. Affairs, the Department of most important to them. When com/hcp/ or call 1.888.4ASSIST Defense, or TriCare. patients enroll in Amgen Assist 360, (1.888.427.7478), Monday through • Patients may not seek reim- their Amgen Nurse Ambassador Friday, 9:00 am to 8:00 pm ET. bursement for value received serves as a single point of contact from the Amgen FIRST STEP to help them find resources. Nurse Amgen FIRST STEP™ Program Program from any third-party Ambassadors are only available to Amgen offers this program for payers, including flexible spending patients that are prescribed certain Blincyto, Imlygic, Kanjinti, accounts or healthcare savings products. Nurse Ambassadors Kyprolis, Neulasta, Neulasta accounts. are there to support, not replace, Onpro, Neupogen, Nplate, Prolia, patients’ treatment plan and do not Vectibix, and Xgeva. The program Other restrictions apply. Amgen provide medical advice or case man- helps eligible commercially insured reserves the right to revise or agement services. Amgen 360 can: patients pay for their out-of-pocket terminate this program, in whole or • Help patients understand how their prescription costs, including in part, without notice at any time. Amgen medicine may be covered, deductible, co-insurance, and and refer them to programs that co-payment. ¶ Amgen First Step coverage limits and may be able to help them afford it, program maximums: such as Amgen FIRST STEP. Patient eligibility requirements: • Program covers out-of-pocket • Refer patients to independent • Patients must be prescribed one of medication costs for the Amgen nonprofit organizations that may the drugs listed above. product only. Program does not provide community resources, • Patients must have private com- cover any other costs related to one-on-one counseling services, mercial health insurance that office visit or administration of the and local support groups. covers medication costs for the Amgen product. drugs listed above.

14 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 15 Amgen

• No out-of-pocket cost for first Certain Medicare Part D patients REIMBURSEMENT dose or cycle; $5 out-of-pocket with product coverage who cannot ASSISTANCE cost for subsequent dose or cycle. afford their out of pocket costs may Maximum benefit of $10,000 per be eligible. It is required that they Amgen Assist 360™ patient per calendar year. (For are able to demonstrate: Connect with an Amgen Reim- Kyprolis and Kanjinti: maximum • Inability to afford the medicine bursement Counselor by phone benefit of $20,000 per patient • Ineligibility for Medicaid or or schedule a visit with a Field per calendar year; for Prolia: $25 Medicare’s low-income subsidy Reimbursement Specialist to out-of-pocket cost for subsequent (Extra Help) receive assistance assistance with dose or cycle, maximum benefit • Have satisfied all payer guidelines reimbursement. of $1,500 per patient per calendar and Prior Authorization (PA) year.) Patient is responsible for requirements prior to applying Visit amgenassist360.com/hcp/patient- costs above these amounts. for assistance support/amgen-access-specialist • Do not have any other financial for more information. To confirm patient eligibility and support options. enroll in one of these programs, visit Amgen Reimbursement Counselors amgenfirststep.com/register-card or To apply, visit amgensafetynet can assist with submitting, storing, call 1.888.65.STEP1 (1.888.657. foundation.com/how-to-apply.html, and retrieving benefit verifications 8371), Monday through Friday, 9:00 select the appropriate medication, for anyone currently on an Amgen am to 8:00 pm ET. complete the Patient Application, product. The Benefit Verification and fax the completed application Center offers the tools, information, Independent Nonprofit to 1.866.549.7239. and support that make a difference Programs to providers and patients. Visit For patients with government The patient and their physician will amgenassistonline.com and select the insurance (like Medicare), Amgen both be notified once a decision specific drug to get started. Assist 360 can refer patients to inde- is made. Once a patient has been pendent nonprofit patient assistance enrolled, they will be contacted For more information, call programs that may be able to help by Amgen Safety Net Foundation 1.888.4ASSIST (1.888.427.7478), them afford the co-pay costs for to provide consent for shipment. Monday through Friday, 9:00 am to their prescribed medicine. Program Prescription products are shipped 8:00 pm ET. eligibility is based on the nonprofit’s directly to the patient. criteria. Amgen has no control over these programs and provides For questions, call 1.888.762.6436, referrals as a courtesy only. Monday through Friday, 8:00 am to 8:00 pm ET. Uninsured Patients 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: • Have lived in the U.S. or its terri- tories for six months or longer • Satisfy income eligibility requirements • Are uninsured or their insurance plan excludes the Amgen medicine or its generic/biosimilar.

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 15 Astellas

Astellas Pharma U.S., Inc.

Oncology-related products: Padcev™ (enfortumab vedotin-ejifv) injection (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 enrollment process. products. To enroll Padcev, Xospata, directly to the patient’s home. or Xtandi Support Solutions, visit Xospata Copay Card Program astellaspharmasupportsolutions.com, Xospata Support SolutionsSM The Xospata Copay Card Program select the appropriate medication, Xospata Support Solutions (astellas is for eligible patients who have and follow the patient enrollment pharmasupportsolutions.com/ commercial prescription insurance. 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 must: patients whose prescription claims To enroll a patient in the Astellas • Have prescription drug insurance are reimbursed, in whole or in part, Patient Assistance Program, • Be new to Xospata therapy by any state or federal government

16 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 17 Astellas

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

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 17 Astellas

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

Astellas Pharma Support Solutions will initiate the benefits verification upon receipt of the specific medi- cation’s Patient Enrollment Form. Once it is complete, a summary of benefits will be sent.

18 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 19 AstraZeneca

AstraZeneca

Oncology-related products: Calquence® (acalabrutinib) capsules, Faslodex® (fulvestrant) injection, Imfinzi® (durvalumab) injection, Iressa® (gefitinib) tablets, Lumoxiti™ (moxetumomab pasudotox-tdfk) for injection, Lynparza® (olaparib) tablets, Tagrisso® (osimertinib) tablets

Patient and Reimbursement Assistance Websites astrazenecaspecialtysavings.com MyAccess360.com

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

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 19 AstraZeneca

available through the AZ&Me REIMBURSEMENT Prescription Savings Program, ASSISTANCE please visit azandmeapp.com. AstraZeneca Access 360™ Eligibility Requirements: Access 360 can assist providers and • Patient must be a resident of the patients with: United States. • Benefit investigation • Patients must be without prescrip- • Prior authorization support tion drug coverage through • Claims and appeal process private insurance or government support. programs • Patient annual income must be For more information, call 1.844. at or below a certain level. ASK.A360 (1.844.275.2360), Monday through Friday, 8:00 am If the patient is a Medicare Benefi- to 8:00 pm ET or visit ciary, they must not be eligible for myaccess360.com. or enrolled in Low Income Subsidy (LIS) for Medicare Part D, and 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.

Please note that faxed applications must be sent from a physician’s office in order for the prescription to be processed.

For more information, please visit azandmeapp.com or call 1.800. AZandME (1.800.292.6363).

20 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 21 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 and physician signatures and date, • Patient has private commercial to 1.855.963.4463. Registered insurance Xofigo Access Services 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 include: Monday through Friday, 9:00 am -us.com/downloads/pdf/MAC-XOF- • Financial criteria based on to 7:00 pm ET. US-0065-1-Xofigo%20Access%20 adjusted gross household income Services%20Enrollment%20 (documentation of income is $0 Commercial Copay Form%20for%20Providers.pdf), required) Assistance Program including the signed patient autho- • Residency in the United States, Patients may be eligible for rization and an assignment of including the District of copayment/coinsurance assistance commercial copay/coinsurance Columbia, Puerto Rico, Guam, or if they have a private commercial assistance, to Xofigo Access Services the U.S. Virgin Islands. plan that covers Xofigo. Patients at 1.855.963.4463. Once approved, approved for assistance will not have the patients will receive an approval To enroll, complete the Xofigo to pay anything to access Xofigo. letter with a commercial copay/coin- Access Services Patient Assis- If patients have public insurance surance identification (ID) card. tance Application (hcp.xofigo-us. (eg, Medicare or other government com/coordinate-patient-care/ payors, such as the Department of Independent Copay/Coinsurance getting-patients-started/patient- Veterans Affairs and Department of Assistance Foundations financial-assistance) and fax the Defense), patients are not eligible. If patients have Medicare or other completed form including patient Eligibility criteria include: government insurance and need

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 21 Bayer HealthCare

assistance with their cost-share Oncology $0 Co-Pay Program requirements apply. Financial assis- requirements for Xofigo, they may For eligible, commercially insured tance may also be available through be eligible for copay or coinsurance patients prescribed Nexavar or independent charitable organizations. assistance through an independent Stivarga, the zero dollar co-pay To speak with a reimbursement copay assistance foundation. Xofigo program allows patients to fill their counselor, call 1.866.2BUSPAF Access Services Access Counselors prescription with no out-of-pocket (1.866.228.7723), Monday through can verify patients’ coverage for costs. Patients can receive up-to Friday, 8:30 am to 6:00 pm ET. Xofigo and provide information $25,000 in saving with no monthly about any available foundation. The maximum. To be eligible patients must: Aliqopa Resource foundations will determine patients’ • Be a United States resident Connections eligibility for copay or coinsurance • Be over 18-years-old The ARC patient support program assistance based on their own • Currently have commercial health offers comprehensive access, reim- criteria. insurance for a portion of their bursement support, and patient prescription drug cost assistance services, including: REACH® • Not be enrolled in any federal • The Bayer U.S. Patient Assis- Patients taking Stivarga or Nexavar or state subsidized healthcare tance Foundation for eligible can enroll in REACH® (Resources program that covers a portion patients who are uninsured or for Expert Assistance and Care of their prescription drug costs, underinsured. Bayer U.S. Patient Helpline). REACH provides including Medicare (such as Assistance Foundation is a char- patients with information about Medicare Part D prescription itable organization that helps their therapy, helps them evaluate drug benefit), Medicaid, TriCare, eligible patients get Bayer pre- their financial assistance options, or any other federal or state scription medicine at no cost. and offers education and support healthcare plan, including phar- • The Temporary Patient Assis- to health care professionals. The maceutical assistance programs. tance Program for patients whose REACH program offers Nurse coverage is delayed or who Counselors to answer medical Enroll online at zerocopaysupport.com experience a temporary lapse in questions and provide educational by clicking on the specific medica- coverage for Aliqopa. and support materials, as well as tion. For questions about the co-pay • The Aliqopa $0 Co-Pay Program guidance on side effects. Financial program, call 1.866.581.4992 from for eligible patients with com- access counselors can provide 9:00 am to 5:00 pm ET. mercial insurance. Patients must help with: not be enrolled in a govern- • Benefit verification and specialty Independent Charitable ment-sponsored program and pharmacy provider (SPP) Organizations must meet certain other eligi- identification REACH can help patients who are bility criteria to qualify for this • Patient Assistance Program (PAP) government insured (e.g., Medicare, program. If approved, the patient for the uninsured or underinsured Medicaid, Military) by giving infor- may pay as little as $0, with a • Prior authorizations and denial/ mation on Part D prescription drug maximum benefit of $25,000 per appeal information plans. Financial assistance may also year. • Co-pay assistance for eligible be available through independent • Referrals to independent assis- commercially insured patients not charitable organizations. tance foundations for publicly previously enrolled in the REACH insured patients and those Commercial Co-Pay Assistance To speak with a reimbursement requiring travel assistance. Program counselor, call 1.866.639.2827, • Referral to independent organi- 9:00 am to 5:00 pm ET. To enroll in the ARC Program, fax zations that may assist eligible the completed enrollment form patients with their out-of-pocket Patient Assistance Program (hcp.aliqopa-us.com/access-and- expenses. Patients who are uninsured or under- reimbursement/arc-program/) insured may be eligible to receive to 833.427.2329. For more For more information, call free medication for up to 12 months information, call 833.ALIQOPA 1.866.639.2827 or visit the through the Bayer U.S. Patient (833.254.7672), Monday through prescribed medication's website. Assistance Foundation. Eligibility Friday, 9:00 am to 7:00 pm ET.

22 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 23 Bayer HealthCare

To enroll in the ARC Program, fax $0 Co-Pay Program TRAK Assist also provides a the completed enrollment form Commercially insured patients may dedicated phone line that provides (hcp.aliqopa-us.com/access-and-re- qualify for $0 co-pay. The Nubeqa patients direct access to a nurse imbursement/arc-program/) to $0 co-pay program benefit has or pharmacist who can answer 833.427.2329. For more infor- a maximum amount of $25,000 questions about treatment with mation, call 833.ALIQOPA per year, per patient. The Nubeqa Vitraki. To enroll patients in TRAK (833.254.7672), Monday through co-pay program is for commercially Assist, download the Vitrakvi Friday, 9:00 am to 7:00 pm ET. insured patients using Nubeqa patient support service request form for an approved FDA indication, and prescription (hcp.vitrakvi-us. DUDE Access Services™ being treated in the U.S., including, com/pdf/MAC-VIT-US-0094-1%20 DUDE (Darolutamide User Drug Puerto Rico, Guam, and U.S. terri- VITRAKVI%20TRAK%20 Experience) Access Services provides tories. Patients who are enrolled in Assist%20Enrollment%20 a range of services and resources for any type of government insurance Form%20Q3%202019%20Update. Nubeqa patients, including: or reimbursement programs pdf) and fax the completed form, • Two months of free treatment for are not eligible. For questions along with copies of the patient’s eligible patients about the Nubeqa $0 Co-pay pharmacy insurance card(s) (front • 0$ co-pay for eligible patients Program, call 1.833.337.DUDE and back), to 1.888.506.TRAK • Referrals to charitable founda- (1.833.337.3833). (1.888.506.8725). For more infor- tions, including the Bayer U.S. mation, please call 1.844.634.TRAK Patient Assistance Foundation TRAK Assist™ (1.844.634.8725). Monday through • Reimbursement and access TRAK Assist provides several Friday, 9:00 am to 7:00 pm ET. support. options to help patients access their Vitrakvi treatment, including: Vitrakvi Commitment Program™ To provide these savings to your • TRAK Assist $0 Co-Pay Program Bayer will provide full or partial patients and benefit from the advan- for eligible patients with com- refunds (for up to 60 days) to tages of DUDE Access Services, mercial or private insurance. patients (through the Bayer complete and fax the Patient Service Patients who are enrolled in any In-Network Specialty Pharmacy) Request form (nubeqahcp.com/ type of government insurance or for patients who do not receive sites/g/files/vrxlpx1306/files/2020-03/ reimbursement programs are not clinical benefit within 90 days of Nubeqa_PatientServiceRequestForm. eligible. initiation on Vitrakvi. Program pdf) to 1-844-NUBEQA3 (1.844. • Vitrakvi Bridge Program for rules apply. For more infor- 682.3723). You can also call 833- commercially insured patients mation, visit hcp.vitrakvi-us.com/ 337-DUDE (1.833.337.3833), whose coverage is delayed or who access or call 1.844.634.TRAK Monday through Friday, 9:00 am experience a temporary lapse in (1.844.634.8725).. to 7:00 pm ET. coverage. This program provides free Vitrakvi for a limited period REIMBURSEMENT Nubeqa Free Trial Program of time while a patient is without ASSISTANCE The Nubeqa free trial program coverage. provides two months’ supply of • Referrals to independent assis- Xofigo Access Services Nubeqa at no cost to patients tance foundations for publicly Xofigo Access Services provides a who meet the program eligibility insured patients who need help variety of services to support requirements and agree to the terms with out-of-pocket costs related access to Xofigo, including: and conditions. To be eligible, the to their treatment. TRAK Assist • Insurance benefit verifications patient must reside in the United offers referrals to third-party • Prior authorization support States or Puerto Rico, and be a assistance programs; eligibility • Claims appeal research and new patient not currently using criteria apply. information Nubeqa or who previously received • Bayer U.S. Patient Assistance • Claims tracking Nubeqa through the free trial Foundation for qualified • Billing and coding information program. For more information uninsured or underinsured • Payer policy information. please call, 1.833.337.DUDE patients. (1.833.337.3833).

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 23 Bayer HealthCare

To access these services, call To provide these savings to patients 1.855.6XOFIGO (1.855.696.3446) and benefit from the advantages of 9:00 am to 7:00 pm ET, Monday DUDE Access Services, complete through Friday. You can also access and fax the Patient Service Request these services online 24/7 through form (nubeqahcp.com/sites/g/files/ the Xofigo Access Services Provider vrxlpx1306/files/2020-03/Nubeqa_ Portal at xofigoaccessonline.com/. PatientServiceRequestForm.pdf) to 1.844.NUBEQA3 (1.844.682.3723). REACH® For more information, call The REACH program offers: 1.833.337.DUDE (1.833.337.3833). • Benefit verification • Specialty pharmacy provider TRAK Assist™ identification TRAK Assist provides access • Prior authorizations support and coverage assistance. • Denial/appeal information. Patient coverage support, includes: • Insurance benefit investigation Visit https://www.nexavar-us.com/ • Prior authorization and appeals co-pay-assistance/ or https://www. support stivarga-us.com/getting-and-paying/ • Sample documentation REACH/ for more information. • Payer policy information.

Aliqopa Resource For more information, please call Connections 1.844.634.TRAK (1.844.634.8725), The ARC patient support program Monday through Friday, 9:00 am to offers comprehensive access, reim- 7:00 pm ET. 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™ A range of support services are available to help patients access therapy, including: • Benefits verification • Prior authorization assistance • Appeal support.

24 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 25 BeiGene

BeiGene

Oncology-related products: Brukinsa™ (Zanubrutinib) capsules

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

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

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 25 Blueprint Medicines

Blueprint Medicines

Oncology-related products: Ayvakit™ (avapritinib) tablets

Patient and Reimbursement Assistance Website yourblueprint.com/hcp/

PATIENT ASSISTANCE Co-Pay Assistance Program at no cost through this program. This program helps eligible, com- Financial eligibility criteria applies. YourBlueprint™ mercially insured patients reduce To apply for this program, complete YourBlueprint case managers work their out-of-pocket costs (co-pay, the enrollment form (yourblueprint. with providers and patients to co-insurance, or deductible) to com/wp-content/uploads/patient-ser- provide seamless support through- as little as $0. Patient may not vices-enrollment-form.pdf) and fax it out treatment. Case managers can seek reimbursement for the value to 1.866.370.3082. help by: received from this program from • Investigating patients’ insurance other parties, including any health Uninterrupted Access benefits insurance program or plan, flexible YourBlueprint offers the following • Connecting patients with financial spending account, or health care no cost options to patients to need assistance options savings account. Offer is not valid if assistance accessing Ayvakit. • Supplying helpful resources, such the patient is enrolled in a federal or as sample letters of necessity state healthcare program (including Coverage delays: The QuickStart • Communicating with the pro- Medicare, Medicaid, TriCare, or program offers a 15-day supply vider’s office throughout the any state medical or pharmaceutical of treatment to newly prescribed process. assistance program), or if the patient patients who have an insurance is uninsured or paying cash for the coverage delay of three days or To enroll, complete the Patient prescription. Blueprint Medicines more. Support Program Enrollment Form reserves the right to rescind, revoke, (yourblueprint.com/wp-content/ or amend the program and discon- Interruption in coverage: The uploads/patient-services-enrollment- tinue support at any time without Coverage Interruption program form.pdf) and fax the completed notice. provides a temporary supply of form with signatures to 1.866.370. treatment to patients already on 3082. The from can also be To begin the process of determining therapy who face a temporary inter- completed online at yourblueprint. patient eligibility and enrollment in ruption in insurance coverage. com/hcp/. A dedicated case manager the Co-Pay Assistance Program, visit will confirm the patient’s enrollment portal.trialcard.com/yourblueprint/. Change in dose: The Dose and initiate the services requested. For any questions, contact customer Exchange program allows patients support at 1.888.BLUPRNT who have their dose titrated to For assistance, call YourBlueprint at (1.888.258.7768). exchange remaining medication for 1.888.BLUPRNT (1.888.258.7768), the new dosage. Monday through Friday, 8:00 am to Patient Assistance Program 8:00 pm ET. If a patient is uninsured or has limited coverage, they may be eligible to receive their medication

26 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 27 Blueprint Medicines

Speak with a dedicated case manger at 1.888.BLUPRNT (1.888.258.7768), Monday through Friday, 8:00 am to 8:00 pm ET.

REIMBURSEMENT ASSISTANCE YourBlueprint™ YourBlueprint is a patient support program designed with patients’ care in mind. YourBlueprint assists patients throughout many aspects of treatment by providing: • Financial assistance options • Prior authorization support • Benefits investigation.

To enroll patients, visit your- blueprint.com/hcp or call 1.888. BLUPRNT (1.888.258.7768), Monday through Friday, 8:00 am to 8:00 pm ET.

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 27 Bristol Myers Squibb

Bristol Myers Squibb

Oncology-related products: Empliciti® (elotuzumab) for injection, Opdivo® (nivolumab) injection, Spry- cel® (dasatinib) tablets, Yervoy® (ipilimumab)

Patient and Reimbursement Assistance Website bmsaccesssupport.com

PATIENT ASSISTANCE two BMS medications in combi- Assistance for nation, the maximum is $50,000. Uninsured Patients BMS Access Support® Other restrictions may apply. Final For patients without prescription Bristol Myers Squibb (BMS) is determination of program eligibility drug insurance, or for patients committed to helping patients gain is based upon review of completed who are underinsured, BMS Access access to their prescribed BMS med- application. Absent a change in Support can make a referral to ications. The BMS Access Support Massachusetts law, effective January independent charitable foundations program provides resources to help 1, 2021, Massachusetts residents that may be able to help, including patients understand their insurance will no longer be able to participate the Bristol Myers Squibb Patient coverage and find information on in this program. Assistance Foundation (BMSPAF): sources of financial support. bmspaf.org. This charitable organi- Obtain the Enrollment Form in one zation may provide free medicine to BMS Oncology of the following ways: eligible, uninsured patients who have Co-Pay Assistance Program • Begin the enrollment process online an established financial hardship. The program provides financial with their secure portal: https:// assistance with out-of-pocket www.mybmscases.com/app/ Patients may be eligible for assis- deductibles, co-pay, or co-insurance login#/. tance through the BMSPAF if they: costs for eligible patients who have • Call BMS Access Support at • Do not have insurance coverage been prescribed certain BMS 1.800.861.0048. Monday through for applicable medication oncology products. Patients partici- Friday, 8:00 am to 8:00 pm ET. • Live in the United States, Puerto pating in any state or federal Rico, or U.S. Virgin Islands healthcare program including The provider’s office and patient • Are being treated by a U.S.-licensed Medicaid, Medicare, Medigap, complete the Enrollment Form. The prescriber Champus, TriCare, VA, or DoD, or patient’s name, address, insurance • Are being treated as an outpatient any state, patient, or pharmaceutical carrier, and member identifi- • Have a yearly income that is at or assistance program are not eligible cation number are required. Fax below 300% of the Federal Poverty for this program. To be eligible, the completed Enrollment Form Level. Medications that are injected patients must have commercial to 1.888.776.2370. BMS Access and certain cancer medications (private) insurance and live in the Support then notifies the provider may be subject to higher limits. United States or Puerto Rico. Enrolled and patient of the result and the patients pay the first $25 of the co-pay appropriate next steps. For questions Other eligibility criteria may apply. for each dose of a BMS medication. or to confirm receipt of the appli- For more information about eligi- Bristol Myers Squibb will cover the cation, call the Support Center at bility and to obtain an enrollment remaining amount up to a maximum 1.800.861.0048, Monday through application, call the Bristol Myers of $25,000 per year, per patient, per Friday, 8:00 am to 8:00 pm ET. Squibb Patient Assistance Foun- product. If a patient is prescribed dation at 1.800.736.0003.

28 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 29 Bristol Myers Squibb

Assistance for Patients guidelines and to submit the with Federally-Funded required documents and information Insurance Plans before the appeal deadline. Patients insured through Federal Healthcare Programs are not eligible To start a benefits review or schedule for co-pay assistance programs a call with a Care Coordinator, visit sponsored by Bristol Myers Squibb, bmsaccesssupport.bmscustomer but BMS Access Support can make connect.com/overview-services. a referral to independent charitable foundations offering support for your specific patient. It is important to note that charitable foundations are independent from Bristol Myers Squibb Company. Each foundation has its own eligibility criteria and evaluation process. Bristol Myers Squibb cannot guarantee that a patient will receive assistance. For details, contact BMS Access Support at 1.800.861.0048.

REIMBURSEMENT ASSISTANCE BMS Access Support Benefits Reviews BMS Access Support can conduct a benefits review. It will review patient coverage for BMS medication and reviews are typically completed within a median time of 24 hours. For enrolled patients, benefits may also be reverified.

Prior Authorization BMS Access Support can assist by providing information about the prior authorization process. The Care Coordinator can conduct benefits review, obtain information about any prior authorization requirement, call the payer to obtain prior authorization details, and fax summary of benefits to the provider.

Claims Appeals If the patient’s insurer has denied coverage, BMS Access Support may be able to assist by providing infor- mation about the appeals process. It is important to review the insurer’s

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 29 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® (lena- lidomide) capsules, Thalomid® (thalidomide) capsules, Vidaza® (azacitidine for injection)

Patient and Reimbursement Assistance Website celgenepatientsupport.com

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

30 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 31 Celgene Oncology

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 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.

To enroll, download the English or Spanish enrollment form at celgenepatientsupport.com/ enrollment/email-or-fax/. Fax the

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 31 Coherus BioSciences

Coherus BioSciences

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

Patient and Reimbursement Assistance Website coheruscomplete.com

PATIENT ASSISTANCE • Must not seek reimbursement • Patient must agree to “soft” amount received from Coherus credit check if no required Coherus COMPLETE™ from any third-party payers, income documentation is Coherus COMPLETE provides a including flexible spending provided. suite of patient support services and accounts or healthcare savings programs designed to assist with accounts. To enroll, visit login.coherus patient access. complete.com and follow the To enroll, visit copay.coheruscomplete. instructions. For any questions, Coherus COMPLETE Co-Pay com and follow the instructions. call 1.844.4.UDENYCA Assistance Program (1.844.483.3692). The Coherus COMPLETE Co-Pay Patient Assistance Program Assistance Program provides eligible Udenyca can be provided at no cost REIMBURSEMENT patients $0 out-of-pocket costs for to eligible uninsured and under- ASSISTANCE each Udenyca dose. The maximum insured patients with financial benefit per claim is up to $7,200 hardship through the Patient Coherus COMPLETE™ with a maximum annual benefit of Assistance Program (PAP). Coherus COMPLETE can provide $15,000, per 12-month enrollment Eligibility criteria: reimbursement support by con- period. Reimbursement is done via • Uninsured or functionally tacting Patient Access Specialists. electronic remit; no physical co-pay uninsured card is required. • United States citizen or resident Insurance Benefit Verification and must physically reside in the Coherus COMPLETE can: To be eligible for the Co-Pay U.S. or a U.S. territory • Provide comprehensive pro- Assistance Program, patients: • Be under the care of a U.S. duce-specific coverage assessments • Must be prescribed Udenyca for licensed provider with an estab- • Determine insurance eligibility a medically appropriate use lished practice located in the U.S. based on a patient’s benefit plan • Must have commercial health • Patients who appear to be and payer policy. insurance that covers the Medicaid eligible must have medication costs of Udenyca received a denial from Medicaid Comprehensive Prior • Must not be covered by any federal, • Diagnosis and dosing must be Authorization (PA) Services state, or government-funded consistent with Udenyca’s FDA Coherus COMPLETE can: healthcare program, such as approved label • Identify payer PA requirements Medicare, Medicaid, Medicare • Adjusted annual household • Assist in PA submissions Advantage, Medicare Part D, income of ≤ 500% of Federal • Provides pre-populated payer Veterans Affairs, the Department Poverty Level (FPL) and pharmacy PA forms when of Defense, or TriCare necessary

32 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 33 Coherus BioSciences

• Track PA determinations with payers.

Pre-populated forms only provide patient and provider demographic information. They do not fulfill clinical requirements that are to be provided by the physician.

Coding and Billing Support Coherus COMPLETE can: • Provide product-specific coding support • Assist with claims submission questions.

Claims and PA Appeals Support Coherus COMPLETE can: • Provide payer guidance for PA or claims denials • Provide guidance on the appeal submission process • Monitor the appeal request.

To get started, please contact 1.844.483.3692, or go to https://www. coheruscomplete.com/home.html

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 33 Eisai

Eisai Co., Ltd.

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

Patient and Reimbursement Assistance Website eisaireimbursement.com

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

34 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 35 Eisai

Fax the Explanation of Benefits For Lenvima, patient support (EOB) or detailed Specialty includes a benefit investigation Pharmacy receipt for the Halaven to help patients understand their claim to 844.745.2350. The coverage. Call 1.866.61.EISAI following information should be (1.866.613.4724) for more infor- included: mation and to enroll patients. • Patient’s information including full name • Date of service • 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 patients prescribed Lenvima, this offer will expire March 31, 2021. For patients prescribed Halaven, this offer will expire November 20, 2021.

REIMBURSEMENT ASSISTANCE The Eisai Assistance Program For Halaven, specialists provide insurance verifications, coverage options, and information about the prior authorization process and the claims and denials process. Call 1.866.61.EISAI (1.866.613.4724) Monday through Friday, 8:00 am to 8:00 pm ET for all questions.

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 35 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

PATIENT ASSISTANCE program—Alimta, Cyramza, Lilly Oncology medications at no Erbitux, or Portrazza cost. Visit LillyCares.com for more Lilly Oncology Support • Have commercial insurance information. Center that covers the prescribed Lilly Through the Lilly Oncology Support Oncology medicine, but does not The program can also help providers Center, Lilly strives to offer person- cover the full cost refer patients to charitable founda- alized treatment support for eligible • Be 18 years of age or older tions that may be able to provide patients prescribed a Lilly Oncology • Be receiving prescribed medicine assistance with medication costs. product. For those who qualify, it for an FDA-approved use These foundations are not affil- can help with: • Be a resident of the United States iated with Eli Lilly and Company • Understanding patients’ insurance or Puerto Rico. and have been established and are coverage operated independently. • Review of financial-assistance Patients may not be participating options, including savings card in any state or federal healthcare For more information, call programs and independent program, including, without lim- 1.866.474.8663, Monday through patient-assistance foundations itation, Medicaid, Medicare, Friday, 8:00 am to 10:00 pm ET. • For some products it provides Medigap, DoD, VA, TriCare, or dedicated, personalized support any state patient, or pharmaceutical Verzenio Continuous through every step of treatment. assistance program; patients who Care™ move from commercial insurance Verzenio Continuous Care is an Lilly Oncology Infused Products to a state or federal healthcare umbrella of support options tailored Co-Pay Program program. to a patient’s entire Verzenio Eligible, commercially insured treatment journey. Once enrolled patients may qualify for savings card Download and print the savings card in the program, patients will have assistance, which may help patients application (lillyoncologysupport. access to the following: manage treatment costs. Patients com/assets/pdf/patient_assistance_ • Assistance with insurance and may pay as little as $25 a month program_application.pdf). Complete coverage when commercially insured, up to and fax the form to 1.877.366.0585. • Dedicated support staff—patients a maximum of $25,000 during a speak to the same person every 12-month enrollment period. To be Independent Patient Assistance time eligible, patients must: Foundations • MyRightDose—a dose exchange • Have been prescribed one of If patients qualify, the Lilly Cares program the following Lilly Oncology Foundation, Inc., an independent • Verzenio savings card medicines covered by the nonprofit organization, may provide • Free loperamide for patients.

36 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 37 Eli Lilly and Company

The Verzenio Continuous Care dose directly to patients’ home in as For any questions, call Lilly Oncology Program is not a guarantee of early as 48 hours and at no cost to Support Center at 1.844.VERZENIO coverage. Terms and conditions them. Additional terms and condi- (1.844.837.9364), Monday through apply for all programs. To enroll, tions apply. Friday, 8:00 am to 10:00 pm ET. complete and fax the Enrollment Form (verzenio.com/assets/pdf/ To apply for this program, complete hcp_enrollment_form.pdf) to the Dose Exchange Program 1.855.545.5857. In order to process Enrollment Form (verzenio. the requested services, Verzenio com/assets/pdf/MyRightDose_ Continuous Care will require Enrollment_Form.pdf). Fax the two patient signatures and a pre- completed form with prescriber scriber signature. Not signing the signature to 1.833.665.6329. Enrollment Form will result in an For more information, call incomplete submission and a delay 1.833.557.2417, Monday through in requested services. Friday, 9:00 am to 6:00 pm ET or visit verzenio.com. For any questions, call Lilly Oncology Support Center at 1.844. REIMBURSEMENT VERZENIO (1.844.837.9364), ASSISTANCE Monday through Friday, 8:00 am to 10:00 pm ET. Oncology Support Center Through the Lilly Oncology Support Verzenio Savings Card Center, we strive to offer individualized Eligible, commercially insured treatment support for eligible patients patients pay as little as $0 a month. prescribed a Lilly Oncology product. Subject to a separate $25,000 For those who qualify, Lilly Oncology maximum annual cap. Offer is good can help with reimbursement (eligibility up to 12-month until December determinations, benefits investigation, 31, 2021. This offer is invalid for prior authorization assistance, and patients without commercial drug appeals information). insurance or those whose pre- scription claims are eligible to be For questions or more information, reimbursed, in whole or in part, call 1.866.472.8663, Monday through by any governmental program, Friday, 8:00 am to 10:00 pm ET. including, without limitation, Medicaid, Medicare, Medicare Part Verzenio Continuous Care™ D, Medigap, DOD, VA, TriCare, or Verzenio Continuous Care can assist any state patient or pharmaceutical with insurance and coverage. assistance program. Card activation is required. Benefits Investigation The program helps patients under- Digital cards can be downloaded stand their coverage options, locate online at verzenio.com/hcp/savings- the appropriate pharmacy, and support and preprinted physical identify their lowest possible cards are available from a Lilly Sales out-of-pocket cost. Specialist for distribution to patients. Field Reimbursement Manager MyRightDose The program can help patients access This dose exchange program may prescribed Lilly FDA-approved simplify midcycle dose reductions medicines. for patients. It ships the appropriate

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 37 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- each treatment for Bavencio, up to actively. A CoverOne representative a maximum of $30,000 per year. CoverOne® will notify patients and providers as Once the annual co-pay assistance Patient Assistance Program soon as possible with the patient’s limit is reached, enrolled patients are CoverOne provides patient access and eligibility determination. responsible for paying all co-pays reimbursement support services to and any balance not covered by help patients gain appropriate access NOTE: The CoverOne patient assi- CoverOne. to Bavencio in the United States. stance program is a philanthropic program for patients in need, and is Enrollment in the co–pay assistance CoverOne recognizes that each not contingent on any past or future program does not guarantee assis- patient’s situation is different and are commercial sale. tance. Whether an expense is eligible dedicated to helping them one at a for the CoverOne Co-Pay assistance time. For more information, contact Co-Pay Assistance Program benefit will be determined at the 844.8COVER1 (844.826.8371), CoverOne provides co-pay time the benefit is paid. Eligible Monday through Friday, 8:00 am to assistance for privately insured co-pay expenses must be in con- 8:00 pm ET. Bavencio® patients with co-pay/ nection with a separately paid claim co-insurance responsibilities who for Bavencio administered in an When Bavencio is used in com- meet the program eligibility criteria. outpatient setting, which is bination with axitinib, questions otherwise covered by a private related to reimbursement and access Healthcare professionals may submit or commercial insurance plan. for axitinib may be referred to Pfizer an application for co-pay assistance Oncology TogetherTM at PfizerRx for their privately-insured patients The patient co-pay assistance Pathways.com. by submitting an enrollment form program is not contingent on any through the CoverOne Enrollment past or commercial sale of Bavencio. Patient Assistance Program Portal (https://www.coverone.com/ The co-pay program does not assist CoverOne includes a patient en/portal/log-in.html) or by faxing with inpatient hospital claims or in assistance program that provides a completed Enrollment Form to any bundled payment arrangement Bavencio at no charge for patients 1.800.214.7295. The offer is not where there is no separate patient who meet certain income, insurance valid for any claims covered, paid or co-pay for Bavencio, and does not (i.e., uninsured), and residency eligi- reimbursed, in whole or in part, by assist with healthcare premiums or bility criteria. To determine patient Medicaid, Medicare, or other federal drug administration services. eligibility, providers should complete or state healthcare programs. Full a CoverOne Enrollment Form on terms and conditions for co-pay assis- the CoverOne Enrollment Portal tance can be found at coverone.com. (coverone.com/en/portal/log-in.html) prior to treatment or fax the Enrolled patients may be eligible completed form to 1.800.214.7295. to pay as little as a $0 co-pay for

38 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 39 EMD Serono

REIMBURSEMENT Active Listening 101 ASSISTANCE Active listening is a communication technique that requires the listener CoverOne CoverOne will help providers and to feed back what is heard to the speaker by re-stating or paraphrasing patients understand the specific what was heard in the listener’s own words. Active listening improves coverage and reimbursement guide- personal relationships, reduces misunderstanding and conflicts, strengthens lines for Bavencio. Reimbursement cooperation, and fosters understanding. The skill is proactive, accountable, support services include: and professional. • Insurance benefit verification • Prior authorization assistance Active listening is comprised of three primary elements: comprehension, • Information on relevant billing retention, and response. codes for Bavencio (HCPCS, CPT, Comprehension—develop a shared meaning between parties through tone ICD-10-CM, NDC) of voice, use of vocabulary and context, and speech pattern. • Denied/underpaid claims Retention—take notes if necessary. assistance • Payer research (non-patient specific) Response—respond both verbally and non-verbally. • Medicare, private payers, state Medicaid. Active Listening Tactics • Listen and hear rather than waiting to speak. EMD Serono, Inc. and Pfizer, Inc. do not guarantee coverage and/or • Watch body language. reimbursement for Bavencio. • Find common ground. Coverage, coding, and reim- • Paraphrase the speaker’s words back to him or her as a question. bursement policies vary significantly (“I see/hear/feel like you are afraid of…”) by payer, patient, and setting of care. Actual coverage and reim- • Suspend your own frame of reference and judgments. bursement decisions are made by • Validate what the speaker is saying and feeling (“You seem to feel angry, individual payers following the is that because…?”) receipt of claims. Patients and healthcare professionals should Barriers to Active Listening always verify coverage, coding, and reimbursement guidelines on a payer • Distractions and patient-specific basis. • Trigger words • Vocabulary Enroll through the CoverOne Enrollment Portal, https://www. • Limited attention span coverone.com/en/portal/log-in. • Emotions html or fax a completed CoverOne Enrollment Form to 1.800.214.7295 • Noise and visual distraction to request services. • Cultural differences • Interrupting or influencing

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

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 39 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 information, call 1.844.900.EASE eligible patients who experience (1.844.900.3273), Monday through EASE Exelixis Access a payer decision delay of five Friday, 8:00 am to 8:00 pm ET. Services® days or more. Limited to on-label Exelixis Access Services (EASE) indications. Additional restrictions REIMBURSEMENT provides a variety of support to help may apply. ASSISTANCE patients get started on treatment • The 15-Day Free Trial Program as soon as possible. EASE can provides free medicine to help EASE Exelixis Access meet the unique needs of patients patients start treatment quickly. Services and practices at each step along Limited to on-label indications. At a provider office’s request, EASE the access journey. EASE offers Additional restrictions and eligi- can provide support with: regionally dedicated case managers bility rules apply. • Benefits investigation as a single point of contact. They • The Dose Exchange Program • Prior authorization can provide the status of patients’ provides a free 15-day supply in • Appeals support and follow-up. access journey, offer prompt support the lower dose to help patients with payer coverage, financial assis- who require a dose reduction. For more information, call tance, and treatment coordination, Additional restrictions and 1.844.900.EASE (1.844.900.3273), and provide proactive follow-up. eligibility rules apply. Monday through Friday, 8:00 am to Services include: 8:00 pm ET. • The EASE $0 Co-Pay Program To apply for these services, ensures that eligible commercially download and complete the appro- This description of the Exelixis Access insured patients pay $0 per month priate form depending on the Services program is for informational for a maximum benefit of $25,000 needed program and EASE Patient purposes only. Exelixis makes no per year. Additional restrictions Authorization Form for Cabometyx representation or guarantee con- and eligibility rules apply. Patients (cabometyxhcp.com/exelixis-access cerning reimbursement or coverage with government insurance are -services#overview) or Cometriq for any service or item. Information excluded. Visit activatethecard. (cometriq.com/hcp/access/). Fax provided through the Exelixis Access com/7311 to enroll eligible the completed forms to 1.884.901. Services program does not constitute patients. EASE (3273). Patients can also medical or legal advice and is not • The EASE Patient Assistance enroll through CoverMyMeds®. intended to be a substitute for a con- Program helps eligible patients Access and submit a prior autho- sultation with a licensed healthcare who cannot afford their drug costs rization request for Cabometyx provider, legal counsel, or appli- receive their Exelixis medicines through CoverMyMeds (https:// cable third-party payer(s). Exelixis free of charge. Additional restric- www.covermymeds.com/main/), reserves the right to modify the tions and eligibility rules apply. and enroll eligible patients in EASE program at any time without notice. • The Cabometyx Quick Start services at the same time. For more

40 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 41 Genentech

Genentech, Inc.

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

Patient and Reimbursement Assistance Website genentech-access.com

PATIENT ASSISTANCE hear from a Foundation Specialist to • Be 18 years of age or older, or let you know if the application was have a legal guardian 18 years Genentech Access approved or if more information of age or older to manage the Solutions is needed. Once the application is program The Genentech Patient approved, it will send the Genentech • Live in and receive treatment Foundation medicine to the patient or the health in the United States or U.S. The Genentech Patient Foundation care provider’s office as directed on Territories gives free Genentech medicine to the form as quickly as possible. • Not be receiving assistance people who don’t have insurance through the Genentech Patient coverage or who have financial For more information, call Foundation or any other co-pay concerns. Patients qualify if they: 888.941.3331, Monday through charitable organization. • Do not have insurance or coverage Friday, 6:00 am to 5:00 pm ET. for their Genentech medicine with There are no income requirements. incomes under $150,000 Genentech BioOncology® Patients pay as little as $5 for their • Have insurance, but can’t Co-pay Assistance Program prescribed Genentech BioOncology afford their out-of-pocket This co-pay assistance program products with an annual benefit costs, have pursued other helps eligible patients pay for pre- limit of $25,000 per product. The forms of financial assistance, scription medication costs. Qualified $5 co-pay applies to FDA-approved and meet certain household patients must: Genentech combination products. size and income requirements • Be covered by commercial or Retroactive requests for assistance (found online at gene.com/ private insurance may be honored for qualifying patients/patient-foundation/ • Receive a Genentech BioOncology patients if the infusion or pre- see-if-you-qualify.) product for an FDA-approved scription fill occurred within 120 indication days prior to enrollment and the If one of these situations applies • Not participate in a federal or patient meets all eligibility criteria fax the completed enrollment state-funded healthcare program, at the time of infusion. No physical forms (gene.com/patients/ such as Medicare, Medicaid, card is needed; patients simply need patient-foundation/apply-for-help) Medigap, VA, DoD, or TriCare their Member ID. to 833.999.4363. You can expect to

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 41 Genentech

To get started, visit copayassistan- helping the patient. Forms can be selecting the prescribed medi- cenow.com. For questions about found by going to genentech-access. cation and selecting the “Forms this program, call 855.MY.COPAY com, selecting the prescribed med- and Documents” section. Appeals (855.692.6729), Monday through ication, and selecting the “Forms cannot be completed or submitted Friday, 9:00 am to 8:00 pm ET. and Documents” or submitted by Genentech BioOncology Access online via My Patient Solutions Solutions on a provider’s behalf. Referrals to Co-pay (genentech-access.com/hcp/my-pa- Assistance Foundations tient-solutions.html). My Patient Solutions Genentech BioOncology Access My Patient Solutions is an online Solutions offers referrals to Prior Authorization Assistance tool to help enroll patients in independent co-pay assistance Access Solutions can help identify Genentech Access Solutions and foundations for eligible patients if a prior authorization (PA) is manage service requests. Features of who are commercially or publicly necessary and offer resources as to My Patient Solutions: insured, including those covered by obtain it. Both the Prescriber Service • Enroll and re-enroll patients Medicare and Medicaid. Form and the Patient Consent Form • Communicate with a Genentech must be received before Genentech Access Solutions Specialist Genentech does not influence or BioOncology Access Solutions can • See which service requests require control the operations or eligibility begin helping the patient. action criteria of any independent co-pay • Co-pay assistance details assistance foundation and cannot If the request for a PA is not granted, • View benefits investigation reports guarantee co-pay assistance after a your BioOncology Field Reim- • Follow up on prior authorizations referral. bursement Manager (BFRM) or (PAs) or appeals Genentech BioOncology Access • Request benefits reverifications. To get started, visit genentech-access. Solutions Specialist can work with com, select a medication, and follow the patient and provider to determine Account registration can be the directions for specific indications. next steps. completed by one person for the entire practice and for multiple REIMBURSEMENT Appeals practice locations. Visit genentech- ASSISTANCE If the patient’s health insurance access.com and follow the instruc- plan has issued a denial, a BFRM tions. For assistance, call 866.422. Genentech BioOncology or Access Solutions Specialist can 2377, Monday through Friday, 6:00 Access Solutions provide resources as the patient am to 5:00 pm ET. Benefits Investigation and provider prepare an appeal Genentech BioOncology Access submission per the patient’s plan Solutions can conduct a benefits requirements. investigation (BI) to help determine if a Genentech medicine is covered, If a plan issues a denial: if prior authorizations (PAs) are • The denial should be reviewed, required, which specialty pharmacy along with the health insurance (SP) the health insurance plan plan’s guidelines to determine prefers, and if patient assistance what to include in your patient’s might be needed. The potential appeal submission outcomes of a BI are: • The BFRM or Access Solutions • Treatment is covered Specialist has local payer coverage • Prior authorization is required expertise and can help determine • Treatment is denied. specific requirements for the patient. Both the Prescriber Service Form and the Patient Consent Form must be Sample letters and additional received before Genentech BioOn- considerations are available cology Access Solutions can begin at genentech-access.com by

42 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 43 GlaxoSmithKline

GlaxoSmithKline

Oncology-related product: Zejula® (niraparib) capsules

Patient and Reimbursement Assistance Website togetherwithgskoncology.com

PATIENT ASSISTANCE a summary-of-benefits call with the Island are not eligible for reim- patient within two business days. bursement of administration fees. Together with GSK Oncology For more information, call 1.844. Patient Assistance Program GSK understands that a cancer 4.GSKONC (1.844.447.5662), Uninsured patients and Medicare diagnosis can be overwhelming for Monday through Friday, 8:00 am patients who meet eligibility require- patients and loved ones. Treatment to 8:00 pm ET. ments may access medication free considerations and costs can add of charge through GSK’s Patient undue stress, especially if patients Commercial Co-pay Program Assistance Program. are unsure what coverage options Eligible patients could pay as little are available or how to access them. as $0 for their medicine. Download To qualify for the Zejula Patient and complete the Together with Assistance Program, patients must: Together with GSK Oncology is GSK Oncology enrollment form for • Live in one of the 50 states, here to help, offering patients and approval. Terms and Conditions apply. District of Columbia, Puerto Rico, healthcare professionals a variety of or U.S. Virgin Islands access and reimbursement services Patients may be eligible based on • Meet one of these criteria: for all GSK oncology products—all general criteria below: • Uninsured in one place. • Have a commercial medical or • Have private commercial prescription insurance plan or are insurance but have no coverage To enroll, complete the enrollment uninsured (medical or pharmacy) for the form (togetherwithgskoncology. • Are a resident of the United product as demonstrated to the com/content/dam/cf-pharma/togeth- States (including the District of program through the defined erwithgskoncology/master/pdf/ Columbia, Puerto Rico, and the Appeals Process criteria (please zejula-enrollment-form-patient- U.S. Virgin Islands) contact program for details) reimbursement-support-program. • Are not eligible for or enrolled in • Not be eligible for Puerto Rico's pdf). Select services requested from a government funded program. Government Health Plan Mi the program and complete all Salud, or have applied and been patient and prescriber information. If the patient is approved, the denied Make sure that both the patient Together with GSK Oncology • Meet certain income eligibility and prescriber sign the form. Fax Commercial Co-pay Program may requirements. Patients whose the completed form, plus copies help with the patient's cost share for income exceeds program eligibility of patient’s medical and pharmacy a GSK Oncology product and the maximum will be provided the insurance cards, to 1.800.645.9043. cost of administration, up to $100 opportunity to demonstrate that per administration for IV products, their eligible medical expenses Together with GSK Oncology will up to a program total of $26,000 bring them within the income contact the prescriber’s office by the annually. Residents of Massachusetts, eligibility criteria (please contact next business day—and will conduct Michigan, Minnesota, or Rhode program for details).

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 43 GlaxoSmithKline

Patients may not be currently receiving prescription drug coverage through a government program (excluding Medicare), which includes Medicaid, VA, DOD, or TriCare benefits. For assistance with the Zejula Patient Assistance Program please call Together with GSK Oncology at 1.844.283.7276.

Quick Start and Bridge Program For patients experiencing delay in coverage at first dispense (Quick Start), or coverage interruptions while already on treatment (Bridge), download and fill out the enrollment form then fax to Together with GSK Oncology at 1.800.645.9043 to check for eligibility.

RIEMBURSEMENT ASSISTANCE Together with GSK Oncology Together with GSK Oncology is here to help. 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 coding information, and providing pay- er-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.

44 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 45 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 patients • Explain other resources and access their prescribed Incyte support available to the patient To enroll, contact IncyteCARES medications and offers information during treatment. at 1.866.708.8806 or complete an and resources that provide extra application at incycarescopay.com. support during treatment. Its team For additional help, call 1.855. is available to patients and their 452.5234, Monday through Friday, Patient Assistance Program caregivers by phone every weekday. 8:00 am to 8:00 pm ET. The IncyteCARES Patient Assistance It helps eligible patients with: Program (PAP) helps eligible patients • Reimbursement support Copay/Coinsurance Program who do not have prescription • Delivery coordination Eligible patients can receive their drug insurance or who have an • Financial assistance options medication for as little as $0 per insurance plan that will not cover • Temporary access for coverage month, subject to monthly and their treatment. Eligible patients can delays annual limits. To qualify, patients receive medication free of charge. • Connection to support resources must: Terms of program may change at • Education and helpful resources. • Have commercial or private any time. prescription drug coverage To enroll, complete and submit • Be a resident of the Unite States To qualify, patients must: the appropriate IncyteCARES or Puerto Rico • Be a resident of the United States medication form at incytecares. • Have a valid prescription for or a U.S. territory com or through the online portal an Incyte medication for an • Have a valid prescription for (https://hcp.incytecares.com/jakafi/ FDA-approved use. an Incyte medication for an enrollment/information-patient. FDA-approved use aspx) for patients prescribed Jakafi. Patients insured under federal or • Meet certain household size and Completed hard-copy forms should state government prescription drug annual income criteria. be faxed to the number indicated on programs—including Medicare Part the form. Once an eligible patient is D, Medicare Advantage, Medicaid, Patients with prescription coverage enrolled, an IncyteCARES represen- or TRICARE—are not eligible. through government programs, tative will: Patients without prescription drug including Medicare Part D, Medicare • Review coverage and costs for the coverage are also not eligible. Advantage, Medicaid, TriCare, or by prescribed medication a health care exchange plan are not • Coordinate patients’ prescription Amount of savings for the purchase eligible. Within two business days and monthly delivery with an of Jakafi will not exceed $11,977 of receiving the enrollment form, appropriate specialty pharmacy per month and $25,000 per year. patients are notified of “conditional

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 45 Incyte Corporation

approval” for the program. This that may offer help. Some assist allows them to receive free medi- with medication costs, transpor- cation for 90 days. Full approval tation or lodging expenses related is only granted once income infor- to treatment, or counseling services, mation is submitted and confirmed. offered at reduced or no cost. Eligibility and availability of these Temporary Access Program assistance programs are determined Eligible patients received a free by the individual organizations. short-term supply of medication. If a patient’s prescription drug RIEMBURSEMENT insurer requires more than a ASSISTANCE three-day wait for determining coverage approval, IncyteCARES IncyteCARES may be able to provide a free IncyteCARES’ mission is to help short-term supply of the prescribed eligible patients access their pre- Incyte medication in the meantime. scribed medications and to offer No purchase contingencies or other information and resources that obligations apply. To qualify, the provide support during treatment. patient must: • Have commercial or private For eligible patients, IncyteCARES prescription drug coverage or a can provide benefits verification healthcare exchange plan. and as-needed prior authorization • Be a resident of the United States or appeal support. For more infor- or a U.S. territory mation, call 1.866.708.8806, • Have a valid prescription for Monday through Friday, 8:00 am an Incyte medication for an to 8:00 pm ET. FDA-approved use • Provide proof of the coverage delay. This may be a notice you or your patient receive from 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.

If patients do not qualify for the IncyteCARES Copay/Coinsurance Program or Patient Assistance Program, it may be able to provide information about other organiza- tions or independent foundations

46 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 47 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 for patients: more information, visit ipsencares. • Reimbursement assistance com/somatuline-patient-support or IPSEN CARES® • Financial Support call 1.866.435.5677. The IPSEN CARES (Coverage, • Patient support. Access, Reimbursement & Onivyde Copay Assistance Education Support) serves as a Somatuline Depot Program central point of contact between Copay Assistance Program Most eligible, commercially insured patients, caregivers, doctors’ offices, Most eligible patients with private patients pay no copay ($0 copay), insurance companies, and specialty insurance pay no copay subject with an annual maximum benefit pharmacies. Patient Access Special- to a maximum annual benefit of of $20,000. Cash-pay patients are ists will check each patient’s $20,000. Program exhausts after 13 eligible to participate. Patients are not pharmacy and medical benefits to injections, or a maximum annual eligible for copay assistance through determine if the medicine is covered benefit of $20,000, whichever comes IPSEN CARES if they are enrolled for the indication the treating first. Cash-pay patients are eligible in any state or federally funded physician has specified. If there are to participate. For cash-pay patients, programs for which drug prescriptions any restrictions, IPSEN CARES the maximum copay benefit amount or coverage could be paid in part or will inform the doctor about the per prescription is $1,666.66, in full, including, but not limited to, additional information required subject to the annual maximum of Medicare Part B, Medicare Part D, by the insurance company for the $20,000 in total. Patient pays any Medicaid, Medigap, VA, DoD, or doctor’s completion. A summary amount greater than the maximum TriCare (collectively, “Government of all the information collected will copay savings amount per pre- Programs”), or where prohibited by be sent back to the doctor’s office scription. Patients must enroll every law. The maximum copay benefit in a single document, called Benefit 12 months from date of acceptance per prescription for cash-paying Verification Results. Patients and to receive a continued benefit. patients is $1,666.66, subject to providers can call 1.866.435.5677, the $20,000 annual maximum. For Monday through Friday, 8:00 Patients are not eligible for copay more information, visit ipsencares. am to 8:00 pm ET, to begin the assistance through IPSEN CARES com/onivyde-patient-support or call enrollment process. Providers can if they are enrolled in any state or 1.866.435.5677. also help patients enroll through the federally funded programs for which online provider portal at: ipsencar- drug prescriptions or coverage could Patient Assistance Program esportal.biologicsinc.com/Account/ be paid in part or in full, including, The Patient Assistance Program Login or download the appropriate but not limited to, Medicare Part (PAP) is designed to provide Ipsen enrollment form from ipsencares. B, Medicare Part D, Medicaid, medications at no cost to eligible com. Fax the signed and completed Medigap, VA, DoD, or TriCare (col- patients. Patients may be eligible to form to 1.888.525.2416. IPSEN lectively, “Government Programs”), receive free medication if they are CARES offers the following services or where prohibited by law. For experiencing financial hardship, have

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 47 Ipsen

no insurance coverage, and received REIMBURSEMENT • Appeals Information: IPSEN a prescription for on-label use of an ASSISTANCE CARES provides information Ipsen medication. Eligibility does not on the payer-specific processes guarantee approval for participation IPSEN CARES required to submit a level I or a in the program. IPSEN CARES offers the following level II appeal, as well as provides reimbursement assistance services to guidance as needed throughout the Both the patient and the healthcare patients and providers: process. provider have to complete the appli- • Benefits Verification: Ipsen cation. To enroll, visit ipsencares. CARES verifies patients’ coverage, Visit ipsencares.com for more com/, select the appropriate med- restrictions (if applicable), and information or call 1.866.435.5677, ication, and either apply through copayment/coinsurance amounts. Monday through Friday, 8:00 am to the provider portal or complete • Prior Authorization: IPSEN 8:00 pm ET. the drug-specific form and fax it CARES provides information on to 1.888.525.2416. For further documentation required by payers assistance, call 1.866.435.5677, on prior authorization specifics Monday through Friday, 8:00 am and make recommendations for to 8:00 pm ET. next steps based on payer policy.

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.

48 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 49 Janssen

Janssen Biotech, Inc.

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

Patient and Reimbursement Assistance Website JanssenCarePath.com

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

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 49 Janssen

Independent co-pay assistance What Janssen CarePath can do on foundations have their own rules behalf of your patients: for eligibility. Janssen has no control • Provide support with dedicated over these independent founda- Care Coordinators for providers tions and can only refer patients and patients to a foundation that supports their • Conduct benefits investigations disease state. Janssen does not and provide insurance coverage endorse any particular foundation. information • Review and explain patients’ insur- JanssenPrescription ance coverage and out-of-pocket Assistance.com costs for Janssen medications JanssenPrescriptionAssistance.com • Help identify financial assistance provides information on afford- options for eligible patients ability programs that may be able • Provide patient support resources. to help. Janssen CarePath Provider Call Janssen CarePath at 877. Portal CarePath (877.227.3728) for The Provider Portal gives you more information on affordability 24-hour online access to not only programs that may be available. enroll eligible patients in the Janssen CarePath Savings Program, but also Johnson & Johnson Patient view their Savings Program trans- Assistance Foundation actions, request and review benefits The Johnson & Johnson Patient investigations, and request prior Assistance Foundation, Inc. (JJPAF) authorization or appeals support. is an independent, nonprofit organi- zation that is committed to helping Create a Provider Portal account eligible patients without insurance at JanssenCarePathPortal.com. For coverage receive prescription any questions, contact 877.CarePath products donated by Johnson & (877.227.3728), Monday through Johnson operating companies. Friday, 8:00 am to 8:00 pm ET. To see if your patient might qualify for assistance, please contact a JJPAF Janssen CarePath Account program specialist at 800.652.6227, Patients can create a personal Monday through Friday, 9:00 am to Janssen CarePath Account at 6:00 pm ET, or visit the foundation MyJanssenCarePath.com where website at www.JJPAF.org. they can learn about their insurance coverage for their Janssen medi- REIMBURSEMENT cation and find support to help them ASSISTANCE stay on track. Janssen CarePath Janssen CarePath helps verify insurance coverage for patients, provides reimbursement infor- mation, helps find financial assistance options for eligible patients, and provides ongoing support to help patients start and stay on prescribed Janssen medications.

50 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 51 Karyopharm Therapeutics

Karyopharm Therapeutics

Oncology-related product: Xpovio® (selinexor) tablets

Patient and Reimbursement Assistance Website karyforward.com

PATIENT ASSISTANCE Xpovio Co-Pay Card Program To enroll in the Xpovio Co-Pay The Xpovio Co-Pay Card program Card Program, fill out the online KaryForward™ may help minimize the out-of-pocket form at qv.trialcard.com/xpovio#/ KaryForward has helpful resources cost for patients with commercial app/layout/patient, or download and information on financial support insurance. The co-pay card may and complete the KaryForward for Karyopharm medications for allow eligible patients with com- Enrollment Form (karyforward.com/ eligible patients. It offers compre- mercial insurance pay as little as wp-content/uploads/2019/05/kary- hensive resources for caregivers, too. $5 per month, with a maximum forward-enrollment-form.pdf), check of $8,000 per month and up to an the “Financial Assistance” box, and KaryForward support includes: annual cap of $25,000. fax it to 1.833.589.1603. • Insurance related services • Financial assistance Patients must meet the following Xpovio QuickStart Program • Patient assistance program criteria to enroll: Patients receiving their first • KaryForward Support Program • U.S. or U.S. territory residency. Xpovio prescription who cannot • Quickstart program Program valid only in the United ascertain coverage or verification • Bridge program States and U.S. Territories. of coverage within 5 business days • Caregiver educational starter kit. • Patient has commercial (private) may be eligible for this program. insurance that covers Xpovio Please complete the KaryForward All services and programs are • Patient has a valid prescription for Enrollment Form (karyforward. subject to eligibility requirements. Xpovio that is consistent with the com/wp-content/uploads/2019/05/ To enroll, download and complete approved indication for multiple karyforward-enrollment-form.pdf) the KaryForward Enrollment Form myeloma. prescription information and check (karyforward.com/wp-content/ the “Xpovio™ (selinexor) Quick- uploads/2019/05/karyforward- Patients are not eligible if they Start” box. Fax the complete form enrollment-form.pdf), check all are uninsured or if they participate to 1.833.589.1603. services the patient is applying for, in any federal or state health care and fax the completed form to program, including without lim- For more information and 1.833.589.1603. itation Medicare, Medicaid, questions, call 1.877.KARY4WD TriCare, Veterans Health Admin- (1.877.527.9493). For more information, call 1.877. istration. This offer is not valid for KARY4WD (1.877.527.9493), Monday cash-paying patients, where Xpovio Nurse Case Managers and through Friday, 8:00 am to 5:00 pm ET. is not covered by the patient’s com- Other Resources mercial insurance, or where the plan KaryForward is pleased to offer reimburses patients for the entire patients and caregivers the option cost of the medication. Other restric- to receive additional support from tions may apply. a dedicated Nurse Case Manager. Nurse Case Managers can provide

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 51 Karyopharm Therapeutics

nonclinical education on patients’ medication, review prescribed dosing schedules, and educate them on what they may expect when taking their medication based upon the full prescribing information.

REIMBURSEMENT ASSISTANCE KaryForward™ KaryForward provides patient support and a resource center for Karyopharm medications.

KaryForward offers insurance related services, including: • Benefit investigation • Prior authorization • Appeal assistance.

To apply for any of these services, download and complete the KaryForward Enrollment Form (karyforward.com/wp-content/ uploads/2019/05/karyforward- enrollment-form.pdf), check the “Insurance Related Services” box, and fax it to 1.833.589.1603.

For more information, call 1.877. KARY4WD (1.877.527.9493), Monday through Friday, 8:00 am to 5:00 pm ET.

52 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 53 Kite Pharma

Kite Pharma

Oncology-related product: Yescarta® (axicabtagene ciloleucel) suspension for IV infusion

Patient and Reimbursement Assistance Website kitekonnect.com

PATIENT AND REIMBURSEMENT ASSISTANCE How to Check for Patient Understanding Kite Konnect™ A diagnosis of cancer is never easy. In addition to complex information Kite Konnect is committed to helping about cancer treatment, patients and families must now understand and patients and healthcare teams deal with the cost of treatment. It is even harder when patients have trouble through out Yescarta treatment. paying for their medications and treatment. For some patients, the finan- Kite Konnect can assist with: cial difficulties begin when they are first diagnosed with cancer. For others, • Patient enrollment: Hospital financial pressures build up over the course of treatment. Before you can portal access, cell order com- help these patients and families, you must first ensure that they understand pletion, and leukapheresis the information you are sharing. Here are some statements or questions scheduling you can use to check how well a patient or family member understands the • Reimbursement support: Benefits information you are providing. investigation, claims appeals, and 3 Please stop me if you do not understand something. I will be happy to support for eligible uninsured and go over the information again. underinsured patients • Logistics support: Connecting 3 Let me know if I am going too fast or too slow. patients with independent founda- 3 Does this information make sense? tions to help with transportation 3 Have I answered your question(s)? and housing • Ongoing commitment: cell 3 Do you have other questions at this time? order tracking and continuous 3 Are you still with me? communication. 3 Am I overwhelming you with this information? Yescarta is only available at author- 3 Should I go into more detail? ized treatment centers. To get your 3 Tell me if I am unclear or if I use words that you do not understand. patients started with Yescarta, enroll your patient using the Kite 3 Please stop me if I begin to explain something that you already Konnect Apheresis Collection App understand. (Vineti Application) (kitekonnect. 3 Is the information I am providing helpful to you? force.com/s/). For further infor- mation, contact 1.844.454.KITE (1.844.454.5483). Source. ACCC Financial Advocacy Network. accc-cancer.org/FAN

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 53 Merck

Merck

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

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

Patient and Reimbursement Assistance Websites merckaccessprogram.com merckhelps.com

PATIENT ASSISTANCE Merck Helps™ Eligibility criteria include: Merck provides certain medicines • Patient must be a United States Merck Access Program and adult vaccines for free to people resident and have a prescription The Merck Access Program (MAP) who do not have prescription drug or for a Merck product from a health may be able to help answer questions health insurance coverage and who, care provider licensed in the U.S. about access and support, including: without assistance, cannot afford • Patient does not have insurance • Benefit investigations, prior their Merck medicines and vaccines. or other coverage for their authorizations, and appeals Its patient assistance offerings include prescription medicine • Insurance coverage for patients several programs. • Patient cannot afford to pay for • Co-pay assistance for eligible their medicine and meet certain patients Merck Patient Assistance income requirements. • Referral to the Merck Patient Program Assistance Program for eligibility This private and confidential Specific income requirement determination program provides certain medicines amounts can be found at merkhelps. • Reimbursement. free of charge to eligible indi- com. Select the patient assistance viduals, primarily the uninsured program and prescribed medication To enroll, visit merckaccessprogram. who, without assistance, could not to see qualifications. com/hcp/, select the prescribed medi- afford needed Merck medicines. cation, and use the online portal Individuals who don’t meet the To apply, patients and providers (merckaccessportal.com/merck/) or insurance criteria may still qualify must complete the Enrollment complete the appropriate enrollment for the Merck Patient Assistance Form for the specific Merck med- form that can be signed and submitted Program if they attest that they have ication. Visit merckhelps.com and electronically. For hard copy forms, special circumstances of financial search for the specific medication, print and fax the completed form to and medical hardship, and their download and complete the medi- 855.755.0518. A program representative income meets the program criteria. cation’s Enrollment Form, and fax will contact the patient and provider. A single application may provide it to the number at the top of the for up to one year of medicine free form. Spanish enrollment forms For further assistance, call of charge to eligible individuals and are available online. For additional 855.257.3932, Monday through an individual may reapply as many applications or assistance, call Friday, 8:00 am to 8:00 pm ET. times as needed. 800.727.5400.

54 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 55 Merck

The Merck Co-pay Assistance Merck Vaccine Patient For any questions, call 855.257. Program for Keytruda Assistance Program for 3932, Monday through Friday, 8:am The Merck Co-pay Assistance Gardasil®9 to 8:pm ET. Program offers assistance to eligible The Merck Vaccine Patient Assis- privately insured patients who need tance Program provides vaccines help affording the out-of-pocket free of charge to eligible individuals, costs for their medication. Co-pay primarily the uninsured who, assistance may be available for without assistance, could not afford patients who: needed Merck vaccinations. • Are a resident of the United States (including Puerto Rico) If you have any questions about • Have private health insurance that the Merck Vaccine Patient Assis- covers Keytruda under tance Program, call 1.800.293.3881, a medical benefit program Monday through Friday, 8:00 am to • Have been prescribed Keytruda 8:00 pm ET. for an FDA-approved indication • Meet all other criteria of the REIMBURSEMENT program. ASSISTANCE The Merck Co-pay Assistance Merck Access Program Program for Keytruda is not valid for Benefit Investigations patients covered under a government The Merck Access Program (MAP) program, as that term is defined can contact insurers to request in the terms and conditions. The coverage and benefits information. program is not valid for uninsured Visit the specific product site for patients. Once enrolled, eligible additional resources. privately insured patients pay the first $25 of their co-pay per infusion. Prior Authorizations The maximum co-pay assistance If a prior authorization is required, program benefit is $25,000 per or for assistance in understanding patient per, calendar year. if a prior authorization is required, MAP may be able to help. The prior To enroll, visit merckaccessprogram- authorization checklist and sample keytruda.com/hcp/the-merck-copay- letter can help healthcare profes- assistance-program/ and use the sionals understand the documents online portal or download the and information that may be helpful enrollment form. Fax the completed when seeking a prior authorization. form to 855.755.0518. As always, providers should check for payer-specific requirements. If the patient is ineligible for this program, they may be able to get Appeals help from an independent co-pay MAP may be able to help the assistance foundation. A represen- healthcare professional’s office tative can provide information about understand the information needed independent foundations that have for an appeal submission. The their own eligibility criteria and appeal checklist and sample appeal application process. letter can help to understand the documents and information that may be helpful when filing an appeal. Please check for payer-specific requirements.

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 55 Mylan

Mylan

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

Patient and Reimbursement Assistance Website mylanadvocate.com

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

56 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 57 Mylan

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

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 57 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® (imati- nib mesylate) tablets, Jadenu® (deferasirox), Kisqali® (ribociclib) tablets, Kymriah® (tisagenlecleucel) suspension for IV infusion, Mekinist® (trametinib) tablets, Piqray® (alpelisib) tablets, Promacta® (eltrombopag) tablets, Rydapt® (midostaurin) capsules, Sandostatin® (octreotide acetate) for injection, Sandostatin® LAR Depot (octreotide acetate) for injectable suspension, Tabrecta™ (capmatinib) tablets, Tafinlar® (dabrafenib) capsules, Tasigna® (nilotinib) capsules, Tykerb® (lapatinib) tablets, Votrient® (pazopanib) tablets, Zometa® (zoledronic acid) for injection, Zykadia® (ceritinib) tablets

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

PATIENT ASSISTANCE To learn more about how PANO can meets financial eligibility help, call 1.800.282.7630. requirements Patient Assistance Now • Have limited or no prescription Oncology (PANO) The Novartis Patient coverage. (Exceptions exist for PANO is the preferred first stop Assistance Foundation individuals with limited pre- for access to Novartis Oncology This foundation may help provide scription coverage.) Patient Support programs. Through access to Novartis medicines to 1-on-1 guidance with a dedicated patients experiencing financial There are two ways to enroll in the case manager, patients will discover hardship and/or have no third- program: which Novartis Oncology Patient party insurance coverage for their • Fill out the PANO Service Request Support programs they are eligible medicines. Please be advised that Form online by visiting to receive and may also be referred access to the medicines distributed patient.novartisoncology.com/ to other services. through the Novartis Patient Assis- financial-assistance/PANO/. tance Foundation, Inc., is free • Download and complete the Support for patients include: of charge to all eligible patients. PANO Service Request Form • Information about financial assis- Novartis is not affiliated with any (patient.novartisoncology. tance that may be available individual or organization that may com/contentassets/2b6c9821f- • Patient support counselors who charge patients a fee(s) to assist them ba24bdfb5a3df0096724ce3/ are able to provide information in in completing applications for our patient-novartis-oncology- more than 160 languages program. These individuals or orga- service-request-form.pdf) and • Patient navigators who provide nizations are acting independently of fax the completed form to one-on-one support specific to a the Novartis Patient Assistance 1.888.891.4924. Providers should patient’s Novartis medication Foundation, Inc., and its affiliates submit their part separately. • Dedicated case managers with and do not have the consent of Once PANO gets both parts, private extensions whom you can Novartis. To be eligible patients must: a case manager will review the contact directly for updates on • Be a U.S. resident patient’s insurance information to patients. • Provide proof of income that determine if they are eligible.

58 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 59 Novartis

For more information, please call Kymriah Cares™ 1.800.282.7630, Monday through Whether patients and providers have Friday, 9:00 am to 8:00 pm ET. questions about Kymriah, treatment center locations, or insurance Novartis Oncology coverage, Kymriah cares can help. Universal Co-Pay Card The Novartis Oncology Universal To learn more, call 1.844. Co-pay Program is available for 4KYMRIAH (1.844.459.6742), 8:00 almost all Novartis Oncology am to 8:00 pm ET. medicines. REIMBURSEMENT Eligible, privately insured patients ASSISTANCE may pay $25 per month and Novarits will pay the remaining Patient Assistance Now co-pay, up to $15,000 per calendar Oncology (PANO) year, per product. The Novartis PANO is the preferred first stop Oncology Universal Co-pay Program for access to Novartis Oncology includes the co-pay card, payment Patient Support programs. Through card, or rebate with a combined 1-on-1 guidance with a dedicated annual limit of $15,000. Patient case manager, patients will discover is responsible for any costs once which Novartis Oncology Patient the limit is reached in a calendar Support programs they are eligible year. This program is not available to receive and may also be referred for patients who are enrolled to other services. Support for in Medicare, Medicaid, or any patients includes: other federal or state health care • Insurance benefits verification program. Novartis reserves the right • information on prior to rescind, revoke, or amend this authorization program and discontinue support • information on denial appeals. at any time without notice. Find out if a patient is eligible to enroll Get started today by submitting in the program by visiting Copay. the PANO Service Request Form NovartisOncology.com or by calling online (https://www.hcp.novartis. 1.877.577.7756. com/access/). To learn more call 1.800.282.7630, Monday through Independent Friday, 9:00 am to 8:00 pm ET. Charitable Foundations There are a variety of independent charitable foundations that may be able to provide additional financial assistance. See a full list of organi- zations at Patient.Novartis Oncology.com.

The organizations and websites listed are independently operated and not managed by Novartis Pharmaceuticals Corporation. Novartis assumes no responsibility for any information they may provide.

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 59 Pfizer

Pfizer, Inc.

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

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

PATIENT ASSISTANCE Pfizer Oncology Together can help or per treatment for the injectable patients understand their benefits medications for select Pfizer medi- Pfizer Oncology and connect them with financial cations through the co-pay savings Together™ assistance resources, regardless of programs. For oral products, At Pfizer Oncology Together, patient their insurance coverage. patients may receive up to $25,000 support is at the core of everything in savings annually. For injectable it does. From helping to identify To enroll patients, providers can use products, the maximum annual financial assistance options to the Provider Portal (https://www. patient savings range from $10,000 connecting patients to resources for pfizeroncologytogether-portal.com/) to $25,000. emotional support, a patients’ needs or download the Patient Support are our priority. Program & Patient Assistance Patients are not eligible for these Enrollment Form (pfizeroncology- programs if they are enrolled in a When patients need support together.com/enroll) and fax the state or federally funded insurance for their day-to-day challenges, completed form to 1.877.736.6506. program, including but not limited Pfizer Oncology Together wants For questions, please call 1.877.744. to Medicare, Medicaid, TriCare, to be a place they can turn to for 5675, Monday through Friday, 8:00 Veterans Affairs health care, a help. That’s why Pfizer Oncology am to 8:00 pm ET. Visit pfize- state prescription drug assistance Together provides patients pre- roncologytogether.com for more program, or the Government Health scribed our medications with a information. Insurance Plan available in Puerto dedicated care champion. Its care Rico. For oral products, the offer champions, who have social work Pfizer Oncology Together will be accepted only at partici- experience, are ready to listen to Co-Pay Savings Program pating pharmacies. This offer is not patients and then connect them to Eligible, commercially insured health insurance. Pfizer reserves the resources that may help with some patients may pay as little as $0 per right to rescind, revoke, or amend of their daily needs. month for the oral medications this offer without notice. For more

60 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 61 Pfizer

information, call 1.877.744.5675 or calendar year. For more information, the reason why and provide infor- visit pfizeroncologytogether.com and call 1.877.744.5675 or visit pfizer mation on payer requirements. select the medication. oncologytogether.com and select the Once the appeal is submitted, medication. Pfizer can follow up with the Pfizer Patient Assistance Program payer to track the progress of the Eligible patients may receive up Support from Independent request until a final outcome is to a 90-day supply of Pfizer medi- Charitable Organizations determined. cation for free, while applying for Pfizer will assist patients with • Online support: Log in to the Medicaid. If patients do not qualify searching for financial support that provider portal to complete and for Medicaid, they may be able may be available from independent submit an online enrollment form, to get a 1-year supply of medi- charitable foundations. These track the status of patient cases, cation for free through the Pfizer foundations exist independently of and for secure messaging with Patient Assistance Program, or at a Pfizer and have their own eligibility Pfizer Oncology Together. savings through the Pfizer savings criteria and application processes. Program. Patients must meet eligi- Availability of support from the Pfizer Oncology Field Reim- bility requirements and reapply as foundations is determined solely by bursement Managers (FRMs) are needed. the foundations. trained to help address specific access issues in person or over To qualify for free medicine, patents Pfizer RxPathways® the phone. They can help educate must meet certain financial require- Pfizer RxPathways connects eligible provider’s staff on Pfizer’s access ments, as well as meet the criteria patients to a range of assistance and reimbursement resources below: programs to help them access their and help address challenging or • Have a valid prescription for the Pfizer prescriptions. Visit urgent Pfizer oncology patient Pfizer medication for which they PfizerRxPathways.com. cases that have been sent to Pfizer are seeking assistance Oncology Together. To get in contact • Reside in the U.S. or a U.S. REIMBURSEMENT with the FRM in your area, call territory ASSISTANCE 1.877.744.5675. • Have no prescription coverage or not enough coverage to pay for Pfizer Oncology Together To get started, providers can use their Pfizer medicine If patients need access or reim- the Provider Portal (pfizeroncology- • Be treated by a healthcare bursement support for their together-portal.com) to download provider licensed in the U.S. of a prescribed Pfizer oncology medica- the enrollment form and fax the U.S. territory. tions, the following support is here completed form to 1.877.736.6506. to help: For questions, call 877.744.5675. The Pfizer Patient Assistance • Benefits verification: Pfizer Monday through Friday, 8:00 am to Program is a joint program of Pfizer can conduct a benefits verification 8:00 pm ET. Inc. and the Pfizer Patient Assistance to determine the patient’s Foundation. The Pfizer Patient Assis- health insurance coverage and tance Foundation is a separate legal out-of-pocket costs. entity from Pfizer Inc. with distinct • Prior authorization: Pfizer will legal restrictions. coordinate with a patient’s insurer to determine the prior authori- If a patient is accepted into the zation requirements, where and Pfizer Patient Assistance Program, how to submit requests, and Pfizer will inform the healthcare typical turnaround times. Pfizer professional by fax and phone and will also follow up with the the patient by phone and letter. insurer on behalf of the patient Uninsured patients may receive free and track the progress until a final medication for up to one calendar outcome is determined. year, while underinsured patients • Appeals assistance: If the patient’s are enrolled through the end of the claim is denied, Pfizer can review

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 61 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 patients without any purchase con- no control over these independent tingency or other obligation. YOU&i™ Instant Savings charitable organizations. Program To enroll, fax the complete YOU&i Eligible patients with commercial YOU&i Dose Exchange Patient Enrollment Form (https:// insurance pay no more than $10 Program imbruvicahcp.com/you-i-support- per prescription for Imbruvica with This program is available to rapidly program-enrollment-form.pdf) to a maximum limit of $24,600 per facilitate a dose reduction for 800.752.5896. calender year. This program applies patients taking the single-tablet to commercial insurance co-pay, formulation should their prescriber REIMBURSEMENT deductible, and coinsurance medi- decide to adjust their dose before ASSISTANCE cation costs. The program cannot be they have finished their current pack used with any other federally-funded of Imbruvica. YOU&i™ Support Program prescription insurance plan which The YOU&i Support Program is includes Medicare Part D, Medicare To enroll, download a Dose a personalized program that helps Advantage Plan, Medicaid, TriCare, Exchange Prescription and Enroll- patients learn about access to or any other federal or state health ment Form (https://imbruvicahcp. Imbruvica, find affordability support care plan, including pharmaceutical com/cll/support-and-resources/dose- options, and sign up for information assistance programs. To enroll in exchange-program/#) and submit and resources to support them along the program, visit https://sservices. the completed form with prescriber’s their treatment journey. Patients will trialcard.comCoupon/YouAndI/. signature to the YOU&i Support learn about access through: For more information, call Program. • Rapid benefits investigation 1.877.877.3536, Monday through • Information on the prior Friday, 8:00 am to 8:00 pm ET. YOU&i™ Support Program authorization process The YOU&i Support Program • Navigating the exception and Independent Charitable can provide access to Imbruvica appeals process. Organizations for new patients who are experi- For patients with federally funded encing insurance coverage decision To learn more about the YOU&i Medicare, Medicaid, or commercial delays. Eligible patients who have Support Program, call 1.877.877. insurance, financial assistance may been prescribed Imbruvica for an 3536, Monday through Friday, potentially be available from inde- FDA-approved indication and 8:00 am to 8:00 pm ET, Saturday, pendent charitable organizations. who are experiencing an insurance 8:00 am to 5:00 pm ET, or visit Contact information for such inde- coverage decision delay greater than its website at imbruvicahcp.com/ pendent charitable organizations is 5 business days can receive a free you-i-support/access-support. available upon request. Independent 30-day supply of Imbruvica. The charitable organizations have their free product is offered to eligible

62 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 63 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.

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 63 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 cedures, or any physician-related marked “Copay Assistance;” service associated with Libtayo. Complete the enrollment form and LIBTAYO Surround® General non–product-specific copays, fax it to 1.833.853.8362. LIBTAYO Surround helps eligible coinsurance, or insurance deductibles • Physician offices or patients can patients access Libtayo and navigate are not covered. Additional program call LIBTAYO Surround at 1.877. the health insurance process. Visit conditions apply. See libtayohcp. LIBTAYO (1.877.542.8296), its website (libtayohcp.com) to com/ for more information. Option 1, Monday through download additional tools and Friday, 8:00 am to 8:00 pm ET. helpful resources about Libtayo The program is not valid for Surround offerings. For more cash-paying customers. To be eligible: Patient Assistance Program information call, 1.877.LIBTAYO • Patients must be insured by a Eligible patients who meet income (1.877.542.8296), Option 1, commercial health plan that requirements and are uninsured, Monday through Friday, 8:00 am to requires a copayment, coinsurance lack coverage for Libtayo, or have 8:00 pm ET. and/or deductible amount for Medicare Part B with no supple- Libtayo. mental insurance coverage may LIBTAYO Surround Copay • Patients must be residents of the receive Libtayo at no cost. Patients Program United States or its territories or without insurance coverage or Eligible patients with commercial possessions. patients with inadequate insurance insurance may pay as little as $0 • Patients must be at least 18 years coverage who need assistance with for Libtayo, which includes any of age. out-of-pocket medication costs may product-specific copay, coinsurance, • Patients must be prescribed be eligible for alternate funding and insurance deductibles—up to Libtayo for an FDA-approved sources for Libtayo. To be eligible: $25,000 in assistance per year. There indication. • Patients must be uninsured, lack is no income requirement to qualify coverage for Libtayo, or have for this program. There are two ways to enroll Medicare Part B with no supple- patients in the LIBTAYO Surround mental insurance coverage. This program is not valid for pre- Copay Program: • Patients must be residents of the scriptions covered by or submitted • Download the LIBTAYO Surround United States or its territories or for reimbursement under Medicare, Enrollment Form (libtayohcp. possessions. Medicaid, Veterans Affairs/ com/-/media/EMS/Conditions/ • Patients must enroll in LIBTAYO Department of Defense, TriCare, or Oncology/Brands/LibtayoHCP/ Surround by signing Section similar federal or state programs. pdf/LIB-19-09-0014%20 9 of the LIBTAYO Surround This program is not a debit card LIBTAYO%20Surround%20 Enrollment Form (libtayohcp. program and does not cover or Enrollment%20Form.pdf?la=en) com/-/media/EMS/Conditions/ provide support for supplies, pro- and check the box in Section 1 Oncology/Brands/LibtayoHCP/

64 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 65 Regeneron and Sanofi

pdf/LIB-19-09-0014%20 REIMBURSEMENT LIBTAYO%20Surround%20 ASSISTANCE Enrollment%20Form.pdf?la=en) and the Health Insurance Porta- LIBTAYO Surround bility and Accountability Act of LIBTAYO Surround provides access 1996 authorization in Section 10. and reimbursement support to help • Patients must have an annual patients receive their medication as gross household income that quickly as possible. Upon receipt of does not exceed the greater of a LIBTAYO Surround enrollment $100,000 or 500% of the federal form, a LIBTAYO Surround Reim- poverty level. bursement Specialist may be able • Other conditions may apply. to provide several types of assis- tance. To enroll, download the For more information, call 1.877. LIBTAYO Surround Enrollment LIBTAYO (1.877.542.8296), Option Form (https://www.libtayohcp. 1, Monday through Friday, 8:00 am com/-/media/EMS/Conditions/ to 8:00 pm ET. Oncology/Brands/LibtayoHCP/pdf/ LIB-19-09-0014%20LIBTAYO%20 Identification of Alternate Surround%20Enrollment%20Form. Sources of Funding pdf?la=en), make sure each field LIBTAYO Surround can help is complete and accurate, sign the patients look for other ways to form, and fax the completed form afford their medication. to 1.833.853.8362.

Potential alternate sources available Upon enrollment, a Reimbursement for patients may include Medicaid, Specialist can provide the following state health insurance exchanges, assistance: Medigap, state pharmaceutical assis- • Benefits investigation, which tance programs. addresses: • How the medication may be For more information, call covered under the patient’s LIBTAYO Surround at 1.877. health plan LIBTAYO (1.877.542.8296). • Acquisition options • The patient’s eligibility for Nurse Advocates financial assistance Patients can contact a LIBTAYO • Any additional coverage Surround Nurse Advocate 24/7 to information to facilitate the receive the following additional patient’s access to medication. support throughout their treatment • Prior authorization assistance journey: to review and explain payer • Information on patient advocacy requirements groups and local support organi- • Appeal assistance when prior zations, transportation services, authorizations are denied and travel and lodging • Claims assistance to address • General patient education questions as healthcare providers • Appointment reminders. prepare claims and to review the status of claims with the patient’s health insurer.

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 65 Sandoz

Sandoz

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

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

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

66 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 67 Sandoz

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.

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 information to 1.844.726.3695.

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

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 67 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 federal employee plans and health If a patient is deemed ineligible, insurance exchanges CareASSIST will notify the provider’s CareASSIST™ • Be residents of the United States office by fax and the patient by CareASSIST helps eligible patients or its territories or possessions. U.S. mail. with access and support for the treatment they've been prescribed, There is no income requirement to CareASSIST Patient Assistance including: qualify for this program. Eligible Program • Access and reimbursement patients will remain enrolled in the For patients who meet program • Financial assistance program for 12 months dating from eligibility requirements for financial • Resource support. the time of approval. Patients will assistance through CareASSIST, be evaluated for continued eligibility medication can be provided at no To enroll, download the Enrollment on an annual basis. As appropriate, cost through the CareASSIST Patient Application (sanoficareassist.com/-/ their enrollment will be renewed. Assistance Program. In order to media/EMS/Conditions/Oncology/ Other conditions apply. be eligible, patients must meet the Brands/sanoficareassist/DTC/pdf/ following requirements: SAUS_ONC_19_03_1902_3_ To get started, download and print • Patient must be a resident of the PSP_Enroll_Form_Copay_INTER- a CareASSIST application (sano- United States or its territories or ACTIVE.pdf?la=en-US) and fax the ficareassist.com/-/media/EMS/ possessions and be under the care completed form to 1.855.411.9689. Conditions/Oncology/Brands/ of a licensed healthcare provider For any questions or assistance, call sanoficareassist/DTC/pdf/SAUS_ authorized to prescribe, dispense, 1.833.WE+CARE (1.833.930.2273), ONC_19_03_1902_3_PSP_Enroll_ and administer medication in the Monday through Friday, 9:00 am to Form_Copay_INTERACTIVE. U.S. 8:00 pm ET. pdf?la=en-US). Make sure the • Patient must have no insurance “CareASSIST Copay Program” coverage or lack coverage for the CareASSIST Copay Program box in Section 1 is checked and prescribed therapy Eligible patients with commercial fax the completed application • Patients with Medicare Part B insurance may pay as little as $0 to 1.855.411.9689. The appli- with no supplemental insurance for their Sanofi Genzyme medicines, cation process can also be started coverage may be eligible including any product-specific copay, by calling 1.833.WE+CARE • Patient must have an annual coinsurance, and insurance deduct- (1.833.930.2273) where a CareASSIST household income that does not ibles—up­ to $25,000 in assistance Patient Access Specialist will assist exceed the greater of $100,000 per year. To be eligible, patients with the next steps. or 500% of the current Federal must: Poverty Level. • Have commercial or private insurance, which includes state or

68 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 69 Sanofi Genzyme

Approved patients may remain assistance programs, and inde- enrolled for up to 12 months. If pendent charitable foundations. longer assistance is required, they may reapply on a yearly basis. To For more information, call 1.833. get started, download and print WE+CARE (1.833.930.2273). a CareASSIST application (sano- ficareassist.com/-/media/EMS/ REIMBURSEMENT Conditions/Oncology/Brands/ ASSISTANCE sanoficareassist/DTC/pdf/SAUS_ ONC_19_03_1902_3_PSP_Enroll_ CareASSIST™ Form_Copay_INTERACTIVE. CareASSIST Patient Access Spe- pdf?la=en-US). Make sure the cialists can help evaluate patients’ “CareASSIST Patient Assistance prescription insurance coverage Program" box in Section 1 is and identify options, including the checked and fax the completed following services: application to 1.855.411.9689. • Insurance verification, including The application process can also be benefits, deductibles, and copay or started by calling 1.833.WE+CARE coinsurance: Full benefit verifi- (1.833.930.2273) where a Care- cation is specific to the prescribed ASSIST Patient Access Specialist will therapy from Sanofi Genzyme and assist with the next steps. the patient’s insurance plan • Prior authorization assistance: Shortly after an application is Patient Access Specialists identify submitted, patients will receive a letter plan-specific requirements and can from CareASSIST informing them provide information about the of the status of their application. A process copy of that letter is also sent to the • Claims management and appeals healthcare provider on the form. assistance: Patient Access Spe- Complete applications are usually cialists can provide information processed within 2 business days. about the appeals process if a denial is received. Alternate Sources of Coverage CareASSIST may be able to identify To learn more, call 1.833.WE+CARE sources of coverage for patients who 1.833.930.2273, Monday through are uninsured or lack coverage, or Friday, 9:00 am to 8:00 pm ET. who need assistance with their out- of-pocket medication costs.

Through CareASSIST, a Patient 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

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 69 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 REIMBURSEMENT Assistance ASSISTANCE SeaGen Secure® For insured patients who cannot afford SeaGen Secure is a comprehensive their coinsurance or out-of-pocket SeaGen Secure® assistance program for patients who costs, assistance is available. To Before patients start treatment, have been prescribed Adcetris or be eligible, patients must have SeaGen Secure Case Managers are Tukysa. For more information about commercial health insurance with available to answer reimbursement SeaGen Secure, call 855.4SECURE coverage for Adcetris or Tukysa, be questions about Seattle Genetics (855.473.2873), Monday through receiving the prescribed medication therapies, including: Friday, 8:00 am to 8:00 pm ET. for an on-label indication, be a • Coverage as determined by a permanent U.S. resident. Patients Benefits Investigation Patient Assistance Program will need to provide income and • Prior authorization assistance For patients with no insurance, the residency documentation if pre- • Appeals assistance. Patient Assistance Program provides scribed Adcetris. If eligible, SeaGen product at no cost. It provides your Secure will send assistance to the Benefits Investigation oral oncology therapy for up to provider on behalf of the patient. Enroll patients in SeaGen Secure one year and the medication must The patient may receive assistance to start the benefits investigation be ordered for each cycle. To be for the duration of their therapy if process. SeaGen Secure will fax eligible, patients must meet income they remain eligible. There are some providers a summary of benefits requirements, be a permanent U.S. program limits/caps. within two business days of resident, and provide income and receiving the completed request, and residency documentation. To enroll, complete the drug the provider will receive a call to name specific Healthcare Provider discuss the results and next steps. To enroll, complete the drug Request Form and Patient Autho- name specific Healthcare Provider rization Form (seagensecure.com) Claims Assistance Request Form and Patient Autho- and fax the completed form to SeaGen Secure Case Managers can rization Form (seagensecure.com) 855.557.2480 or e-mail it to Case- help providers track claims to ensure and fax the completed form to [email protected]. To they are being processed and paid on 855.557.2480 or e-mail it to Case- reach a SeaGen case manager, call time. Case managers can also assist [email protected]. To 855.4SECURE (855.473.2873). with denied or underpaid claims. reach a SeaGEn case manager, call 855.4SECURE (855.473.2873). Quick Start Program] To speak to a Case Manager, call The Quick Start Program provides 855.4SECURE (855.473.2873), a 15-day supply of product at no Monday through Friday, 8:00 am to cost to patients who experience an 8:00 pm ET. insurance-related access delay.

70 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 71 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 Co-pay Program Odomzo Patient Access Program Eligible commercially insured coordinator will conduct a benefits Yonsa Support™ patients may pay as little as $10 investigation to help better under- Yonsa Support is a simple pathway for Yonsa with the co-pay card. stand patient’s coverage and the to savings and support services that Subject to a maximum benefit of costs associated with treatment. provides a comprehensive resource $5,000 per fill and up to $12,000 Once a benefits investigation is for patients taking Yonsa. Support per calendar year. This offer is not complete, Odomzo Support can: programs are subject to terms and valid for patients without com- • Verify and explain patient benefits conditions and patients must be mercial inurance coverage or if • Process the prescription with a enrolled in Yonsa Support to qualify. prescription is paid for by any state Specialty Pharmacy These services, include: or federally funded health care • Inform patients of their co-pay • Co-Pay Program: Yonsa Support program, including but no limited to support options and other will determine a patient’s eligibility Medicare, Medicaid, VA, DOD, or financial support services and enroll them into the program. TriCare. The program is available to • Coordinate payment and delivery • Early Access Program: Yonsa United States, Guam, Virgin Islands, of Odomzo. Support will enroll eligible or Puerto Rico residents only. Yonsa patients who experience a delay in Support will determine a patient’s To enroll, fill out and fax the coverage. The program provides eligibility and enroll them into the Odomzo Sun Patient Access free product for up to 30 days. program. Additional restrictions Program Application (odomzo. • Patient Assistance Program: and eligibility requirements apply. com/themes/custom/odomzo/global/ Yonsa Support will research Visit activatethecard.com/7702/# to pdfs/Sun-Pharma-Patient-Assis- alternate forms of funding enroll patients and learn additional tance-Program-Application.pdf) (including the patient assistance information. to 877.872.6575 to start the program) and, if the patient is process. For more information eligible, will help with enrollment. If you have any questions regarding or any questions, call the Income documentation is required. eligibility or benefits, call the program at 1.844.5.ODOMZO YONSA Savings program at (1.844.563.6696), Monday through To apply, complete a patient enroll- 1.855.984.6307, Monday through Friday, 8:00 am to 8:00 pm ET. ment form (yonsarx.com/wp-content/ Friday, 8:00 am to 8:00 pm ET. uploads/2019/02/YONSA-Support- Co-pay Program Enrollment-Form.pdf) and fax it to Odomzo Patient Access Eligible, commercially insured 1.877.872.6575. Program patients 18 years or older may The Odomzo Patient Access Program pay as little as $10 a month for For any questions, contact Yonsa streamlines access to Odomzo for an Odomzo prescription, subject Support at 1.855.44 YONSA patients and providers. Once the to a $15,000 maximum annual (1.855.449.6672). enrollment form is received, an program benefit. After the program

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 71 Sun Oncology

maximum, patients will be respon- tigations, reimbursement, and case Application (odomzo.com/themes/ sible for the difference. This offer is management. When a physician custom/odomzo/global/pdfs/ valid only for patients with com- sends a prescription for Odomzo to Sun-Pharma-Patient-Assistance- mercial insurance and who have a a specialty pharmacy, the pharmacy Program-Application.pdf) valid prescription. This offer is not will verify benefits and submit a to 877.872.6575 to start the valid under Medicare, Medicaid, or prior authorization request. It will process. For more information any other federal or state program, then coordinate payment and follow or any questions, call the for cash-paying patients, where the up to ensure patient receives the program at 1.844.5.ODOMZO product is not covered by patient’s medication. (1.844.563.6696), Monday through commercial insurance, or where a Friday, 8:00 am to 8:00 pm ET. plan reimburses patient for the entire REIMBURSEMENT cost of prescription drug. One card ASSISTANCE per patient, not transferable, and cannot be combined with any other Yonsa Support™ offer. Additional terms and condi- Yonsa Support is a comprehensive tions may apply. resource for patients taking Yonsa. It can investigate a patient’s insurance Patients can activate this card coverage benefits, obtain information by calling 1.877.ODOMZO.1 on prior authorization, and inves- (1.877.636.6961) or by visiting tigate claim denials. www.activatethecard.com/7436. To enroll, complete a patient Other Financial Support enrollment form (yonsarx.com/ Services wp-content/uploads/2019/02/YON- People who are publicly insured or SA-Support-Enrollment-Form.pdf) uninsured and need help paying for and fax it to 1.877.872.6575. For Odomzo can be referred to a patient questions, contact Yonsa Support at assistance foundation. A program 1.855.44YONSA (1.855.449.6672). coordinator can further assist providers and patients with this process. To Odomzo Patient Access apply, patients must provide insurance Program information, recent income documen- The Odomzo Patient Access tation, and the name of the referring Program Application is used to physician. Visit www.PanFoun- verify patient benefits and establish dation.org for more information. prior authorization requirements. Providing complete and accurate Independent co-pay assistance information will ensure a timely foundations have their own rules response to benefits investigation for eligibility. Sun Pharmaceutical requests. Once the benefits investi- Industries, Inc. cannot guarantee a gation is complete, the coordinator foundation will help. Sun Pharma will: does not endorse or show financial • Verify and explain patient benefits preference for any particular • Provide information on prior foundation. authorization requirements, including the appeals or denial Specialty Pharmacies process Specialty pharmacies manage the • Process the prescription with a handling and service requirements Specialty Pharmacy. of Odomzo and offer a range of services to patients including To enroll, fill out and fax the product distribution, benefits inves- Odomzo Patient Access Program

72 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 73 Taiho Oncology

Taiho Oncology

Oncology-related product: Lonsurf® (trifluridine and tipiracil) tablets

Patient and Reimbursement Assistance Websites taihopatientsupport.com

PATIENT ASSISTANCE Patient Assistance Program or the provider completes it The Taiho Patient Program can electronically. Taiho Oncology Patient provide financial assistance to • Call 1.844.TAIHO.4U Support™ eligible patients who have insuffi- (1.844.824.4648), Monday Accessing treatments can be chal- cient or no prescription insurance. through Friday, 8:00 am to 8:00 lenging at times. Taiho Oncology Eligible patients may receive Lonsurf pm ET, for help with enrollment. Patient Support offers personalized at no cost based on assistance, services to give patients, care- financial, and medical criteria. Once enrolled, healthcare providers givers and healthcare professionals can expect a Taiho Oncology Patient (HCPs) the help they need in getting Alternate Funding Support Support Reimbursement Specialist started with Lonsurf. This includes Taiho Patient Support can also to confirm the patient’s enrollment insurance verification, help with refer eligible, public- or govern- and share next steps. Patients can medication costs, and treatment plan ment-insured patients to nonprofit expect a welcome to the program support. foundations for co-pay or other and explanation of their insurance assistance. Taiho Oncology does not benefits for Lonsurf. Co-pay Assistance Program influence or control the decisions of Eligible patients may pay $0 per these co-pay assistance foundations. REIMBURSEMENT treatment cycle for Lonsurf. Patients Each foundation has its own criteria ASSISTANCE may be eligible if they: for patient eligibility. Taiho Oncology • Have commercial prescription cannot guarantee financial assistance Taiho Oncology Patient insurance coverage for Lonsurf once a patient has been referred. Support • Reside within the United States, The Taiho Oncology Patient Support Puerto Rico, or U.S. territories There are three ways to enroll in Program simplifies access for those • Use a specialty pharmacy or Taiho Patient Support: who have been prescribed Lonsurf as hospital outpatient pharmacy • Complete the Patient Enrollment part of their treatment. Just a phone • Receive medication from a Form in English (taihopatient- call away, it can help determine doctor’s office. support.com/Content/downloads/ insurance coverage, coordinate pre- enrollment-form-english- scriptions, and more. Patients are not eligible for the March2019.pdf) or Spanish co-pay program if they are reim- (taihopatientsupport.com/ Access and Reimbursement bursed under Medicaid, Medicare, Content/downloads/enrollment- Support drug benefit program, TriCare, or form-spanish-March2019.pdf) The program can help patients other state or federal programs. To and fax it to 1.844.287.2559. understand their insurance coverage determine patient eligibility, call • The patient completes the Patient and/or out-of-pocket responsi- 844.TAIHO.4U (844.824.4648). Enrollment Form online and bility through benefit verifications, brings it to the provider’s office, determine prior authorization

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 73 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 in English (tai- hopatientsupport.com/Content/ downloads/enrollment-form-en- glish-March2019.pdf) or in Spanish (taihopatientsupport.com/Content/ downloads/enrollment-form-span- ish-March2019.pdf) and fax it to 1.844.287.2559, or the patient can complete the enrollment form online and bring it to the provider’s office to complete manually or electroni- cally. For help, call 1.844.TAIHO.4U (1.844.824.4648).

74 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 75 Takeda Oncology

Takeda Oncology

Oncology-related products: Alunbrig® (brigatinib), 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 Monday through Friday, 8:00 am to old. Additional terms and condi- 8:00 pm ET or visit here2assist.com/ tions apply. Takeda Oncology patient/home. Here2Assist™ To enroll, visit takedaoncologycopay. Takeda Oncology Here2Assist is Takeda Oncology Co-Pay com or call to speak with Takeda a comprehensive support program Assistance Program Oncology Here2Assist case manager committed to helping patients For patients with commercial at 1.844.817.6468. navigate coverage requirements, insurance concerned about their out- identify available financial assis- of-pocket costs for Alunbrig, Iclusig, Takeda Oncology Patient tance, and connect with helpful and Ninlaro, the Takeda Oncology Assistance Program resources throughout their Co-Pay Assistance Program may be If patients are uninsured or the pre- treatment. able to help. Patients could pay as scribed medication is not covered by little as $10 per prescription with their insurance, they may be eligible to To enroll, download the Takeda an annual maximum benefit of receive medication at no cost through Oncology Here2Assist Enrollment $25,000. this program. To be eligible for the Form (here2assist.com/pdf/ Patient Assistance Program, patients Takeda_Oncology_Here2Assist_ This offer cannot be used if patients must meet certain financial and Enrollment_Form.pdf) and fax are a beneficiary of, or any part insurance coverage criteria. the completed and signed form of their prescription is covered or with original signatures, a copy of reimbursed by: (1) any federal or A Patient Assistance Program the patient’s insurance card, and state healthcare program (Medicare, Application (here2assist.com/pdf/ 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 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, be provided to the provider’s office or (3) insurance that is paying the within 2 business days. For more entire cost of the prescription. information, call 1.844.817.6468, Patients must be at least 18 years

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 75 Takeda Oncology

If the patient qualifies, they may REIMBURSEMENT be enrolled for up to 1 year. Upon ASSISTANCE enrollment, a Takeda Oncology Here2Assist case manager will notify Takeda Oncology the patient and their healthcare Here2Assist™ provider. A 1-month supply of their Once enrolled in Takeda Oncology medication will be delivered to the Here2Assist, case managers can patient at no cost. Each month a work with patients and their Takeda Oncology Here2Assist case healthcare provider to determine manager will confirm with patient their coverage options and provide and provider that they are still additional support throughout their being treated and are eligible to treatment. receive another month’s supply of medication. To enroll, download the Takeda Oncology Here2Assist Enrollment RapidStart Program Form (here2assist.com/pdf/ If patients experience a delay in Takeda_Oncology_Here2Assist_ insurance coverage determination of Enrollment_Form.pdf) and fax at least 5 days, they may be eligible the completed and signed form to receive a one-month supply along with a copy of the patient’s of their medication at no cost. insurance card and prescription to To receive a RapidStart supply, a 1.844.269.3038. Prescription is completed Takeda Oncology Here- only valid if received by fax. Call 2Assist Enrollment Form must be on 1.844.817.6468, option 2, Monday file, and a RapidStart Request Form through Friday, 8:00 am to 8:00 pm must be completed and submitted ET, for more information. (drug-specific forms are available at here2assist.com/patient/home.) Velcade Reimbursement Additional terms and conditions Assistance Program apply. Tekeda Oncology Here2Assist can provide the information needed Velcade Reimbursement throughout a patient’s treatment. Assistance Program Case managers can connect patients From finding financial assistance to and providers to personalized understanding the disease, Tekeda support for Velcade. Call to speak to Oncology Here2Assist can provide a case manager at 1.844.817.6468, the information needed throughout option 2, Monday through Friday, a patient’s treatment. Case managers 8:00 am to 8:00 pm ET or visit can connect patients and providers www.Here2Assist.com. 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.

76 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 77 TerSera Therapeutics

TerSera Therapeutics

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

Patient and Reimbursement Assistance Website terserasupportsource.com

PATIENT ASSISTANCE enroll for Zoladex, or visit activa- enroll_form.pdf) and fax the form tethecard.com/7774 to enroll for to 855.836.3066. For more infor- TerSera Support Source Varubi. For questions regarding the mation, call 855.686.8725, Monday TerSera is committed to help remove Varubi or Zoladex co-pay card, call through Friday, 9:00 am to 6:00 pm the financial and access barriers that 1.844.864.3014, Monday through ET. so often get in the way of patients Friday, 8:00 am to 8:00 pm ET. who are prescribed Zoladex and Varubi Varubi. Patient Assistance To apply to the Varubi Patient Programs Assistance Program, download the Co-Pay Assistance Zoladex enrollment form (documents.tersera. The Zoladex and Varubi co-pay The challenges of dealing with a com/varubi/VarubiEnrollmentForm. cards provide medical and treatment can be made more difficult pdf) and fax the completed form pharmacy benefits for eligible when a person lacks any form of to 1.855.836.3066. For more patients. Eligible commercially insurance. TerSera is committed information, call 1.855.686.8725, insured patients could pay as little to helping eligible patients access Monday through Friday, 8:00 am to as $0 co-pay with a maximum Zoladex through the Patient Assis- 8:00 pm ET. benefit of $2,000 per calendar year tance Program. If patients qualify, and a maximum benefit of $200 they may get free TerSera medicine REIMBURSEMENT per fill for Varubi. For Zoladex, for up to 1 year. TerSera will send ASSISTANCE eligible commercially insured an application for renewal once the patients could pay as little as $0 patient’s enrollment ends. Medicines TerSera Support Source co-pay with a maximum benefit can be sent to the patient’s home or TerSera Support Source provides a of $300 per one month supply the doctor’s office; most medicines comprehensive suite of services to and $900 per three month supply are sent in a 90-day supply. Patients help patients get the treatment they with a maximum annual benefit of may qualify for the program if they: deserve, including: $2,000 per calender year. Eligible • Are a U.S. Resident, or a Green • Reimbursement information cash paying patients will receive Card or Work Visa holder • Prior authorization information up to $300 off each one month • Meet certain household income • Benefits investigation supply of Zoladex. Patients are limits • Appeals support. not eligible if prescriptions are • Do not have prescription drug paid by any state or other federally coverage that helps pay for Visit terserasupportsource.com for funded programs, including but not TerSera medicines. more information. limited to Medicare or Medicaid, Medigap, VA, DOD, or TriCare, To apply, complete the Patient or where prohibited by law. Visit Assistance Program enrollment form activatethecard.com/7526 to (zoladexhcp.com/pdf/patient-assist-

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 77 TEVA Oncology

TEVA Oncology

Oncology-related products: Bendeka® (bendamustine hydrochloride) for injection, Granix (tbo-filgrastim)® injection, 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 The 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, families and assistance from other programs. form at tevacore.com/resources local communities. For decades, For a listing of these other assis- and fax it to 1.866.676.4073. For Teva has been working through tance programs go to tevacares.org/ questions, call 1.888.587.3263, its Patient Assistance Programs to otherresources/. Monday through Friday, 9:00 am to improve patient access to medication 6:00 pm ET or visit TevaCORE.com. and ensure that cost is not a barrier REIMBURSEMENT to treatment. Teva’s commitment ASSISTANCE to patients provides certain Teva medications at no cost to patients in CORE the United States who meet certain The reimbursement and insurance insurance and income criteria. To process can be complicated. determine if your patient qualifies, Comprehensive Oncology Reim- review the Teva Cares Foundation bursement Expertise (CORE) is Patient Assistance Programs eligibility available to help eligible patients, requirements online at tevacares.org/ their caregivers, and healthcare doiqualify or r call 1.877.237.4881, professionals navigate the reim- Monday through Friday, 9:00 am bursement process. CORE offers a to 8:00 pm ET. Then download the range of services: appropriate enrollment application • Benefit verification and coverage for the prescribed medication at determination tevacares.org/doiqualify and fax the • Precertifications/prior authori- completed form to 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

78 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 79 ACCC REGIONAL MEETINGS ARE NOW VIRTUAL!

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* ACCC Cancer Program Members, Individual Members, and members of the 2020Oncology PATIENT State ASSISTANCE Societies at& REIMBURSEMENTACCC GUIDE 79 accc-cancer.org/drugdatabase

Association of Community Cancer Centers Oncology Drug Database

Find comprehensive coding, billing, and reimbursement information for every approved oncology drug in a single, easy-to-use location, including information on both provider-administered (Part B) and provider-prescribed (Part D) drugs.

Search for a generic or brand name drug to find information on:

· Billing (HCPCS, NDC) and diagnosis (ICD-9 and ICD-10) codes

· Medicare payment limits (does not include the reduction due to sequestration)

· Reimbursement amounts

· FDA-approved indications

· Drug manufacturer information, including contact information for the medical affairs department and reimbursement specialists

For more information, visit accc-cancer.org/drugdatabase Questions on how to use the ACCC Oncology Drug Database? Email [email protected].

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80 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 81

PAP.drugdatabasead.8x10.75.indd 1 2/20/18 4:38 PM 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 under the age of 18 are eligible, Adaptive will notify patients of but require the application form their qualification status and work Adaptive Assist™ to be signed by a parent or legal with them to find appropriate Adaptive Biotechnologies under- guardian support. For more information call stands that each patient’s situation is • Be uninsured or have insurance 1.855.236.9230 or visit clonoseq. unique. It is committed to providing that does not cover the full cost of com/adaptive-assist. guidance and support during each clonoSEQ testing step of the insurance process. That’s • Meet financial need requirements why it offers the Adaptive Assist based on the patient’s income and Patient Support Program: to help the number of persons in their facilitate access to clonoSEQ testing household or sum of medical services for patients who could expenses as a percentage of benefit from the clinical insights household income provided by next-generation mea- • Submit a completed and signed surable residual (MRD) testing. application form (clonoseq.com/ wp-content/themes/clonoseq/ For questions, call the Patient dist/pdfs/PM-US-CORP-0002-3_ Support Team at 1.855.236.9230, Adaptive_PSP_ApplicationForm_ Monday through Thursday, 9:00 am WEB_bbe12ba1.pdf) including to 7:00 pm ET, and Friday, 9:00 am acknowledgment of the require- to 5:00 pm ET. ment to submit a tax return, W-2, pay stub, or other compa- Patient Support Program rable document demonstrating Adaptive Biotechnologies is financial need if and when selected committed to providing financial for participation in the upfront assistance opportunities to qualified enrollment audit. clonoSEQ patients with a demon- strated financial need and in Neither the application nor the accordance with the terms of the Patient Support Program constitute Patient Support Program. To be a contract. Adaptive Biotechnol- eligible for enrollment, a patient ogies retains the right to change must meet all of the following the program in whole or part at criteria: any time in the exercise of its sole • Be a U.S. citizen or legal resident discretion. age 18 years or older. Patients

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 81 Foundation Medicine

Foundation Medicine

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

Patient and Reimbursement Assistance Website foundationmedicine.com/

PATIENT ASSISTANCE relapsed, refractory, metastatic, or the patient and doctor in pursuing advanced stages III or IV cancer. appeals to minimize the financial Patient Financial • This is their first time having a burden. If the patient is eligible for Assistance Program FoundationOne CDx test for this financial assistance, this is applied to Foundation Medicine’s billing cancer diagnosis or have had a Foun- their out-of-pocket cost. and reimbursement services are dationOne CDx test before, but designed to make comprehensive this is a different type of cancer—a Note: If the patient has private/ genomic profiling accessible “new primary” cancer diagnosis. commercial insurance, a prior autho- to patients regardless of their • They have decided to seek further rization form may be required in financial situation. Depending cancer treatment such as thera- some cases. on the specific test, patients may peutic chemotherapy; and already have coverage through • Their testing is ordered by a Medicare or private insurance. If treating physician. patients are uninsured or concerned about the out-of-pocket cost of Note: If the patient is a Medicare/ testing, fill out a financial assitance Medicare Advantage customer, they application or contact the Care may need to sign an Advance Benefi- Team at 888.988.3639, Monday ciary Notice (ABN) prior to the test through Friday, 8:00 am to 8:00 order. The physician will determine pm ET. Payment plans may also be if an ABN is required. available based on patients’ financial situation. To apply for financial Patients with Private Insurance assistance or download a paper Foundation Medicine will work application, visit foundationmed- directly with insurance companies to icine.com/patients#financial-support. try to obtain coverage. Depending on the terms of the insurance plan, Patients with Medicare the patient may have financial For many patients with advanced responsibility for co-pay, co-insurance, solid tumor cancer, FoundationOne or deductible as directed by the plan. CDx is covered by Medicare. If the patient is on Medicare and meets the If the insurance company denies following criteria, they may not have coverage, with patient consent, out-of-pocket expenses for their Foun- Foundation Medicine will work on dationOneCDx solid tumor testing: behalf of the patient to attempt to • The patient has either recurrent, obtain coverage and will work with

82 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 83 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 83 84 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 85 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 85 86 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 87 ACCC 37th [VIRTUAL] National Oncology Conference

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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. 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 89 ASSOCIATION OF Other Patient Assistance Programs & Resources COMMUNITY CANCER CENTERS 880+ FINANCIAL cancer programs ADVOCACY and practices 2,325+ enrolled NETWORK participants Other Patient Assistance Programs & Resources in 50 states

Agingcare.com® in the community that can help • Housing agingcare.com patients with prescription assistance, • Income Assistance transportation for healthcare, and • Tax relief AgingCare.com connects families other assistance options. • Transportation Financial Advocacy Boot Camp who are caring for aging parents, • Employment. Powerful Training to Boost Your Financial Navigation Services! spouses, or other elderly loved ones A program or foundation’s eligi- with the information and support bility will be listed along with its If patients have Medicare and have they need including the Prescription contact information. Aunt Bertha limited income and resources, they Two sets of dynamic online courses offer the tools Drug Assistance Program Locator: will provide “Next Steps” to may be eligible for the Medicare Part “The Financial Advocacy Boot Camp explains all aspects your staff needs to help patients pay for treatment— agingcare.com/Articles/prescription- help patients with the application D Low-Income Subsidy or Extra of financial advocacy and is a great tool for new while maximizing reimbursement at your program. drugassistance-program-locator- process. Help. Patients may be able to get advocates and experienced professionals. Our team 171753.htm. Search for prescription extra help paying for prescription Shape up your team's skills with introductory courses: will be more prepared and confident with this tool.” drug assistance programs by state, BenefitsCheckUp® drug costs if: • Financial Advocacy Fundamentals Angie Santiago, CRCS-I, Lead Financial Counselor–Oncology, medication name, or browse a list of benefitscheckup.org • Their income is less than $19,380 • Enhancing Communication Thomas Jefferson University Health System, Sidney Kimmel nationwide non-profit prescription if single and $26,100 if married Cancer Center • Improving Insurance Coverage drug assistance programs. The National Council on Aging • They have resources less than • Maximizing External Assistance (NCOA) is a respected national $14,610 if single and $29,160 if • Developing and Improving Financial Aunt Bertha leader and trusted partner helping married. Advocacy Programs and Services Who Should Enroll? AuntBertha.com older adults meet the challenges Financial advocates, nurses, patient navigators, social workers, of aging through services like To apply, patients must live in Then continue the learning with advanced content: pharmacists and techs, medical coders, administrative staff, cancer Aunt Bertha’s network connects BenefitsCheckUp. BenefitsCheckUp one of the 50 states or the District program administrators, and other healthcare professionals. people seeking help and verified is a comprehensive, free online tool of Columbia. Apply online at: • Oncology 101 for Financial Advocates social care providers that serve them. that connects older adults with benefitscheckup.org/medicare-rx-ex- • Proactive Assessment of Financial Distress Cost benefits they may qualify for. The tra-help-application-welcome. • Cost-Related Health Literacy FREE to ACCC and Oncology State Society at ACCC members, Aunt Bertha has created a social BenefitsCheckUp team monitors the • Measuring and Reporting and $155 for non-members. Join ACCC as an Individual care network that connects people benefits landscape for updates and CancerCare® Member ($155) to access this resource—and others—for free. and programs—making it easy for changes to policies and programs. cancercare.org people to find social services in It matches patients’ unique needs Additional course to be released in 2020: their communities, for nonprofits to benefit programs and eligibility CancerCare is a leading national • Health Policy Landscape to coordinate their efforts, and for requirements using its compre- organization dedicated to providing ENROLL at accc-cancer.org/FANBootCamp customers to integrate social care hensive tool. free, professional support services into the work they already do. including counseling, support There are over 2,500 federal, state, groups, educational workshops, Its interactive map (company. and private benefits programs publications, and financial assistance The ACCC Financial Advocacy Network is supported by: auntbertha.com/for-customers/ available to help. After reviewing to anyone affected by cancer. All socialcarenetwork/) illustrates initial results, patients can enter CancerCare services are provided by comprehensive coverage of social more details to personalize their oncology social workers and world- care programs in every United States report of benefits they are most leading cancer experts. Limited Cornerstone Partner Silver Partners county, including state and national likely to qualify for. Patients can assistance from CancerCare is programs. Select any county to view start enrolling in programs right available to eligible individuals for the breakdown of program cate- away. Here are the types of expenses treatment-related costs such as trans- The Association of Community Cancer Centers (ACCC) is the leading education and advocacy gories (such as housing and financial patients may get help with: portation, home care, and child care. 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 assistance) and use the map filter to • Medication If applying for financial assistance, screening and diagnosis, treatment options, and care delivery models continue to evolve—so has select interactive geographic areas. • Food CacerCare does not have access to ACCC—adapting its resources to meet the changing needs of the entire oncology care team. For • Utilities process any incoming or outgoing 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. List and then “Financial Assistance.” • Education mail. All correspondence during this Aunt Bertha lists several options • Healthcare time must be done electronically 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. 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 89 Other Patient Assistance Programs & Resources

through email or fax. As a non- coinsurance, and deductibles for COPAY (866.552.6729), Monday profit organization, funding depends their prescribed cancer treatments. through Thursday, 9:00 am to on the sources of support Can- To qualify for assistance, patients 7:00 pm ET, and Friday, 9:00am cerCare receives at any given time. must meet certain financial, medical to 5:00 pm ET. If CancerCare does not currently and insurance criteria. Grants can Cancer Financial have funding to assist a patient, be awarded if funding is available. Assistance Coalition professional oncology social workers CCAF funds are disease specific. cancerfac.org will always work to refer patients to The patient’s diagnosis must match other financial assistance resources. CCAF’s fund definition. If CCAF CFAC is a coalition of financial Check cancercare.org periodically does not have funds available for a assistance organizations joining for funding updates. specific disease, it will refer patients forces to help cancer patients expe- to another foundation that may be rience better health and well-being Financial Assistance Program able to assist. by limiting financial challenges. In order to be eligible for its financial It educates patients and providers assistance program patients must: In order to be eligible for assistance: about existing resources and links • Have a diagnosis of cancer • Patient’s primary cancer diagnosis to other organizations that can confirmed by an oncology must be the same as one of the disseminate information about healthcare provider funds that CCAF covers. the collective resources of member • Be in active treatment for cancer • Patient must have a valid Social organizations. • Live in the U.S. or Puerto Rico Security number to apply for assis- • Meet CancerCare eligibility guide- tance and receive treatment in the CFAC is a coalition of organizations lines based on the Federal Poverty United States. and cannot respond to individual Limit. • Patient must be in active treatment requests for financial assistance. To or have a treatment plan in place find out if financial help is available, Steps for applying to this program, prior to applying for assistance. use the CFAC database at cancerfac. include: • Patient is required to have valid org. Search by cancer diagnosis or 1. Call 800.813.HOPE (4673) insurance coverage. Some funds by specific type of assistance or need and speak with a CancerCare are restricted to assist only those (i.e., co-pays general living expenses, social worker to complete a brief insured through a federal health transportation, genetic testing). interview. They can be reached insurance program such as Patients and providers may also Monday through Thursday, 10:00 Medicare or TriCare. contact each CFAC member organi- am to 6:00 pm ET, and Friday, • Patient income level must be at zation individually for guidance and 10:00 am to 5:00 pm ET. or below 500% of the Federal possible financial assistance. 2. If patients are eligible to apply, Poverty Level. CancerCare will: Co-Pay Relief • Mail/email the patient an CancerCare provides a streamlined copays.org individualized barcoded enrollment process that instantly application determines eligibility. Apply online The Patient Advocate Foundation • Request documentation to (cancercare.org/copay-apply) or (PAF) Co-Pay Relief Program (CPR) verify the patient’s income. speak with a Co-Payment Specialists provides direct financial assistance to 3. Patients must submit a completed at 866.55.COPAY (866.552.6729). qualified patients with co-payments, application to the email or fax Patients will be enrolled for up to co-insurance, and cost-sharing number listed on the form. one year from the time they are associated with prescription med- approved. ications through funds dedicated CancerCare® Co-payment to specific disease states. In some Assistance Foundation Patients with private insurance must instances, assistance with insurance cancercarecopay.org contact the drug company that man- premiums and/or ancillary services ufactures their medication before associated with the disease also may CancerCare Co-payment Assistance applying with CCAF for assistance. be available. Program Specialists Foundation (CCAF) helps qualified For more information, call 866.55. are available to personally guide patients afford the co-payments, patients through the application and

90 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 91 Other Patient Assistance Programs & Resources

enrollment process. Patients approved free-prescription-discount-card) is has a premium assistance program for assistance are required to have available online or through mobile for patients who need help paying their verified diagnosis and treatment app. There are no fees or eligibility their monthly medical insurance plan along with supporting docu- requirements. This program can premiums. Its Travel Assistance mentation completed and returned be used to obtain savings on pre- program helps pay for travel costs within 30 days of approval to ensure scription drugs that are excluded to ensure patients have access to the continuation of the award. by insurance plans, not covered care they need. because patients have exceeded their Eligibility requirements: plan’s maximum limits, or the free Good Days has streamlined the • Patients must be currently insured prescription discount card’s price enrollment process so patients can and have coverage for medica- is lower than a patient’s program’s receive immediate determination of tion(s) seeking financial assistance. co-payment amount. eligibility for financial assistance. • Patients must have a confirmed Eligibility criteria: diagnosis and treatment plan. With the Drug Price Look-up Tool • Patient must be diagnosed with a • Patients must reside and receive (familywize.org/drug-price-look- covered disease and program must treatment in the United States. up-tool), patients can enter the name be accepting enrollments • The patient’s income must fall of their medication and zip code, • Patient must have a valid Social at or below 300 percent or 400 and it will show them the pharmacy Security number to apply for assis- percent of the Federal Poverty savings for that specific medication. tance and receive treatment in the Guideline (FPG) with consid- United States eration for the Cost of Living The prescription discount card must • Patient must be seeking assistance Index (COLI) and number in the be presented with each prescription for a prescribed medication that household. to a participating pharmacy to is FDA approved to treat the be eligible for the discount price. covered diagnosis If the patient is eligible for assistance, Pricing is always the lesser of the • Patient is required to have valid the application will be instantly discounted price or pharmacy’s retail insurance coverage approved, and the patient will be price. If the pharmacy’s price is less, • Patient income level must meet enrolled into the program. The there is no discount. The card can- program guidelines. patient will have immediate access to not be used with other prescription their award and pharmacy card. drug discount cards or for prescrip- To enroll, go to mygooddays.org/ tions paid through a health plan or apply and either apply online or Patients and providers can apply pharmacy benefit plan. All pricing download the English and Spanish online at copays.org/portal/#/login and benefits are subject to change enrollment forms and fax completed or call 1.866.512.3861. without notice. Additional restric- forms to 214.570.3621. For any tions may apply. questions or for assistance with FamilyWize® filling out the enrollment forms, call familywize.org Learn more at familywize.org, or 877.968.7233, Monday through call 800.222.2818 Friday, 8:00 am to 5:00 pm CT. FamilyWize partners with nearly all pharmacies nationwide to negotiate Good Days® HealthWell Foundation® prescription discounts, so patients mygooddays.org healthwellfoundation.org receive a lower price. FamilyWize understands patients are looking to Good Days is a non-profit advocacy When health insurance is not enough, reduce the cost of prescription medica- organization that provides resources for HealthWell Foundation fills the gap tions, and its goal is to help do that. The life-saving and life-extending treatments by assisting with copays, premiums, pharmacy discount card is for everyone to people in need of access to care. deductibles and out-of-pocket nationwide, whether or not patients expenses. It provides financial assis- have health insurance coverage. Good Days covers what insurance tance to help with: does not—the co-pays for treat- • Prescription copays The free FamilyWize Prescription ments that can extend life and • Health insurance premiums, Discount Card (familywize.org/ alleviate suffering. Good Days also deductibles, and coinsurance

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 91 Other Patient Assistance Programs & Resources

• Pediatric treatment costs bursement Request Form for times Patients, providers, pharmacies • Travel costs. when they need it. can apply online at lls.org/support/ financial-support It offers financial assistance through For questions, call 800.675.8416 a number of Disease Funds, with new to speak with a HealthWell repre- Patients and providers call also funds opening every year, so they can sentative, Monday through Friday, apply over the phone and get more get the care they need. 9:00 am to 5:00 pm ET. information about the LLS Co-Pay Assistance Program by calling To be eligible, patients must meet The Leukemia & 877.557.2672, Monday through certain criteria: Lymphoma Society Friday, 8:30 am to 5:00 pm ET. • HealthWell must have a disease Co-Pay Assistance Program fund that covers the patient’s illness, lls.org Support for this program is based on and their medication must be an the availability of funds by disease eligible treatment for that illness. The Leukemia & Lymphoma Society diagnosis. • Patients must have some form of (LLS) Co-Pay Assistance Program health insurance such as, private offers financial support toward the Patient Aid Program insurance, Medicare, Medicaid, or cost of insurance co-payments and/ The Patient Aid Program provides TriCare or insurance premium costs for financial assistance to blood cancer • Patients have incomes up to 400 prescription drugs. Patients must patients. Eligible patients will receive percent to 500 percent of the qualify both medically and finan- a one-time $100 stipend to help federal poverty level (HealthWell cially for this program. The LLS offset expenses. There are no income considers household income, the Co-Pay Assistance Program offers criteria to qualify for this program. number in the household, and the financial help toward: Program continuation is dependent cost of living in the patient’s city • Medical insurance premiums on the availability of funds and or state) • Treatment-related co-pays, the program could be modified or • Patients must be receiving treatment deductibles, and co-insurance (for discontinued at any time if funding in the United States. expenses covered by the program) is limited or no longer available. • Prescription medication related to To be eligible, patients must: Anyone with the patient’s express prescribed treatment. • Be a United States citizen or permission may apply on behalf of a permanent resident of the U.S. patient in two ways: To be eligible for Co-Pay Assistance, or U.S. territories 1. Apply online using the HealthWell patients must: • Have a confirmed diagnosis provider portal at https://healthwell- • Have a household income at or of blood cancer, be in active foundation.secure.force.com/ below 500 percent of the U.S. treatment, scheduled to being 2. Apply by phone at 800.675.8416, Federal Poverty Guidelines as ad- treatment, or in follow up care, all Monday through Friday, 9:00 am justed by the Cost of Living Index attested to by the patient or care to 5:00 pm ET. • Be a United States citizen or team memeber permanent resident of the U.S. or • Patients may be insured or Providers, pharmacists, and social U.S. territory uninsured. workers must use the online • Have medical and/or prescription provider or pharmacy portal to insurance Apply online (lls.org/support/finan- complete and submit an application. • Have a blood cancer diagnosis cial-support/patient-financial-aid) confirmed by a doctor. Patient or by phone at 877.557.2672, Once patients are approved for a must be in active treatment, Monday through Friday, 8:30 am grant from one of the Disease Funds, scheduled to begin treatment, to 5:00 pm ET. they receive assistance for a rolling or is being monitored by 12 months, after which they can their doctor. (See a list of Medicine Assistance Tool reapply if needed and if funding is covered diagnoses here: lls. medicineassistancetool.org available. Upon approval, patients org/support/financial-support/ will receive both a HealthWell co-pay-assistance-program). Pharmaceutical Research and Pharmacy Card and a Reim- Manufacturers of America’s

92 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 93 Other Patient Assistance Programs & Resources

Medicine Assistance Tool (MAT) the “Patient Savings” tab on the savings card, 7-30 day free trial is a search engine designed to help NeedyMeds website, or search offers, or free samples. There are patients, caregivers, and health for the medication name using the a variety of ways to receive the care providers learn more about search feature in the upper left hand offers: some may be printed right the resources available through corner of the screen. If using the from their website, others require the various biopharmaceutical brand or generic name medication registration, filling out a question- industry programs. MAT is not its search function: naire, or even obtaining a sample own patient assistance program, 1. Click on the first letter of the med- from the doctor’s office. but rather a search engine for many ication’s name in the alphabet bar. • NeedyMeds Drug Discount Card of the patient assistance resources 2. Click on the name of the medicine can help save up to 80 percent off that the biopharmaceutical industry to access the eligibility and contact the price of prescription medica- offers. information for the program(s). tions. No personal information or registration is required and The tool has three steps: Enter Your PAPs can also be found by searching the drug discount card is free of Medications, My Background and the Program Name List or by charge. The card cannot be used in My Resources. In the final step, looking through the Company Name combination with any insurance. users can review resources that may List, both found under the “Patient Download a card and learn more be available based on the medica- Savings” tab on the NeedyMeds about its benefits at www.needymeds. tions and background information website. If an application form is org/drug-discount-card. Information entered. Each resource has a available through a PAP, look for it on other drug discount cards are also description and buttons for learning in the “Program Applications” list. available on the NeedyMeds website. more from the program’s website or Look for all medications, not just • Diagnosis-Based Assistance: for applying. the most expensive ones. There are many government and privately-funded programs that MAT offers other resources, Applications Assistance: help with costs associated with a including: There are many local programs and specific diagnosis. Some programs • A list of other healthcare assistance individuals that help people apply are national in scope, while others resources at https://medicine to prescription assistance programs, are limited to people in specific assistancetool.org/My-Resources? All will help for free or at a low states. Most have some type of sec=all-resources&cat=13 cost. They help with such things as eligibility requirements, usually • A list of discount drug card finding a program for prescription financial ones. Some cover one programs at https://medicine medications, completing of the specific diagnosis, while others assistancetool.org/My-Resources? application forms, and working cover whole categories (such sec=all-resources&cat=3 with physicians who must sign the as all types of cancers) or even • Information about the cost forms. Help can be found at www. all chronic medical illnesses. of prescription medicines at needymeds.org/local-programs. You NeedyMeds has compiled a medicineassistancetool.org/ can find local programs in two ways: database (needymeds.org/ Medicine-Cost-Information. 1. Enter the patient’s zip code to find copay-diseases) of diagnosis-based a program in their area or assistance programs that can be NeedyMeds 2. Search by state. searched. It’s best to search by needymeds.org the type of diagnosis. Other ways If a medicine does not appear on to search for assistance are by NeedyMeds is a non-profit that the brand name or generic name lists, looking for programs that serve connects people to programs that then it is not available through a PAP. a specific geographical area. If will help them afford their medi- Other assistance options include: you know the name of a specific cations and other healthcare costs. • Coupons, Rebates & More lists program about which you want Each program has its own qualifying offers of brand name medicine more information, you can also criteria. To find a patient assistance (over-the-counter and pre- search by name of program. program (PAP) that patients may scription) and medical supplies. qualify for click on the brand name These offers may be in the form or generic name search page under of a printable coupon, rebate,

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 93 Other Patient Assistance Programs & Resources

Assistance with • Live and receive treatment in the in the United States or one of its Government Programs: United States or U.S. territories. U.S. territories. Every state has programs to help They don’t have to be a U.S. citizen. needy families and individuals with To connect with case management the cost of healthcare. NeedyMeds In most cases, assistance starts services, call 1.800.532.5274 or has compiled a database of programs on patients' approval date and apply online at patientadvocate.org/ and helpful tools and information to continues for 12 months or until connect-with-services/case-management- navigate these programs. Users can the grant is used in full, whichever services-and-medcarelines/. search these programs by clicking comes first. If more help is needed, on a state, the District of Columbia, the patient may be able to apply for MedCareLine: A division of PAF, the or U.S. territory. Programs and additional funding. MedCareLine’s team of professional their guidelines vary from state to case managers assist with disability, state. NeedyMeds also has a list of For questions about applica- health insurance navigation including Medicaid sites where you can learn tions or income verification, call prior authorization, appeals for denied more about Medicaid in your state, 1.866.316.7263. services, second opinion options, and as well as general information on screening for clinical trials. The Medicaid. Patient Advocate case managers also assist patients Foundation who are experiencing financial For all questions, call 1.800.503.6897, patientadvocate.org challenges that are impacting their or email [email protected]. ability to pay for care and basic The Patient Advocate Foundation cost of living expenses like housing, Patient Access Network (PAF) is a national non-profit charity utilities, food and transportation, Foundation that provides direct services to researching and linking them to panfoundation.org patients with chronic, life threat- available financial support programs ening, and debilitating diseases to that may meet some of these needs. The Patient Access Network (PAN) help access care and treatment rec- Uninsured patients are also supported helps underinsured people with ommended by their doctor. It offers by the program with direct support life-threatening, chronic, and rare the following services: in accessing public programs, health diseases get the medications and treat- Case management services: Profes- insurance enrollment, and charity care ments they need by assisting with their sional case managers at PAF work that will allow access to necessary out-of-pocket costs and advocating with the mission to identify and care. For more information, for improved access and afford- reduce the challenges that indi- visit patientadvocate.org/con- ability. Providers and patients can viduals have when seeking care for nect-with-services/case-manage apply for assistance using the online their disease. Case management ment-services-and-medcarelines. self-service portals at panfoundation. services are available on behalf of org/index.php/en/apply, or by calling patients meeting all of the following Co-Pay Relief Program: The PAF 866.316.7263, Monday through criteria: Co-Pay Relief Program, one of the Friday, 9:00 am to 7:00 pm ET. • Have a confirmed diagnosis of a self-contained divisions of PAF, chronic disease, a life-threatening provides direct financial assistance To qualify for a financial assistance disease, or debilitating disease, to insured patients who meet certain program, the patient must: or be seeking screening services qualifications to help them pay for • Be getting treatment for the related to symptoms or suspicion the prescriptions and/or treatments disease named in the assistance of a chronic, life-threatening, or they need. This assistance helps program debilitating disease patients afford the out-of-pocket • Be taking medication that's • Be in active treatment, had costs for these items that their covered by their health insurance treatment within the past 6 insurance companies require. For and listed in the assistance months, or going into treatment in more information, visit copays.org. program the next 60 days • Have an income that's at or below • Be a U.S. citizen or permanent Financial Aid Funds: This inde- the Federal Poverty Level listed by resident of the U.S. pendent division of Patient the assistance program • Be receiving treatment at a facility Advocate Foundation provides

94 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 95 Other Patient Assistance Programs & Resources

small grants to patients who meet information they need to keep patients' insurance copay, or the financial and medical criteria. up-to-date, including: pharmacy cash price. Visit rxassist. Grants are provided on first-come org/coupon/generic?type=patients, first-served basis and are distributed • Pharmacy Director: Receive or call 1.877.537.5537 for more until funds are depleted. Qualifica- information about formulary information. tions and processes for each fund management, treatment protocols, may differ based on fund require- compliance, and research RxVantage, Inc., is an ACCC Sponsor ments. Patients who are interested • Reimbursement Specialist: Keep in applying for financial assistance the billing team updated on the RxHope™ should start by calling this division latest coding information, cleaning rxhope.com at 855.824.7941 or by registering up claims and reducing write-offs an account and submitting an • Clinical Research Director: Meet Healthcare providers and their staff application online at financialaid. with MSLs to learn about the can set up accounts online to order patientadvocate.org. newest clinical trials, set up data free medications for their patients collection protocols, and share through the RxHope automated For questions, call 1.800.532.5274, patient outcomes. patient assistance online system. If Monday through Thursday, 8:30 am providers and staff would like to to 5:00 pm ET, and Friday, 8:30 am RxAssist create a free account for one healthcare to 4:00 pm ET. rxassist.org provider, visit rxhope.com/Prescriber/ SetupAccount.aspx. To set up a free RxVantage, Inc. RxAssist offers a comprehensive account and place orders online the rxvantage.com database of patient assistance following criteria are required: programs, as well as practical tools, • The user must be a healthcare The volume of information in news, and articles so that health care provider or their staff oncology is growing exponentially. professionals and patients can find the • A valid state license number for From the hundreds of new oral and information they need. Go to rxassist. the healthcare provider infusion drugs developed annually org/search and search by either med- • An email address (this will become to new indications and constantly ication name or company name. the user's login) changing codes, organizations may • The medication for which the no longer be able to afford access If an application is available online, patient is applying to this information via manual users can either open (download) • The patient’s first and last name. processes. RxVantage offers a the application, type information fully digital solution, connecting directly onto the application on Once the above information is the entire team to oncology pro- the screen and print it out, or print available, go to rxhope.com/Prescriber/ fessionals and expert resources to out the application and fill it out Register.aspx and follow the instruc- provide the information they need to by hand. If there is no application tions. You will be setting up your deliver the best possible patient care. online, use the phone number free account and creating an order provided at the top of the “Program for the patient all at the same time. RxVantage offers a searchable Details” page to call the company database of oncology professionals for information on how to get an RxHope acts as a guide through in your area and the medications, application. the patient assistance maze and devices, and services they offer. provides the critical link between Instant messaging within the RxAssist Discount Card patients and healthcare providers platform provides a fast and secure With the RxAssist Prescription and ultimately with the pharmaceu- method of communication. Discount Card, patients can save up tical companies. It can determine to 80 percent off brand and generic if patients are eligible for patient Educational Experiences for your medications. Savings are possible assistance and then help them start Entire Team with or without insurance, and the application process. Patients can Invite the entire cancer care team there is no additional cost to use the initiate the patient assistance process to create a free account with card. RxAssist guarantees the lowest by following a few steps: RxVantage to access the specific price between its discounted price,

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 95 Other Patient Assistance Programs & Resources

1. Enter their contact information When enrolling, patients will need to and select the medication for provide the following information: which they are applying • Name and contact 2. Review the program guidelines information and requirements that will be • Date of birth listed on the screen • Information on allergies and 3. Follow the instructions and print current medications out the request for the healthcare • Income and household size provider to complete. • If ordering a prescription, for faster service, patients To complete the request, make sure can include their credit care to click on the blue link that says information at this time. “Apply Online Now.” Once patients are enrolled, their Rx Outreach® provider should e-Prescribe or fax rxoutreach.org their prescription to Rx Outreach, or the provider can mail a hard copy Rx Outreach is a fully-licensed prescription, as well. non-profit mail order pharmacy that ships medications directly to For any questions, call 1.888. patients’ homes or the provider’s RXO.1234 (1.888.796.1234), office. To make this process simple Monday through Friday, 7:00 am and cost-effective, RxOutreach ships to 5:30 pm CT, or email questions@ enough medication for 30, 60, 90, rxoutreach.org. or 180 days at a time. RxOutreach is available to qualifying individuals and families. Patients can be on Medicare, Medicaid, or other health insurance and still qualify. It serves people whose income is at or below 400% of the Federal Poverty Line. Patients can quickly check their eligi- bilty online at https://rxoutreach.org/ find-out-if-youre-eligible/.

Patients and providers can enroll in Rx Outreach in three ways: 1. Download and print the paper application (rxoutreach.org/ wp-content/uploads/2019/09/ Rx-Outreach_Application- 9.19-fillable.pdf), and fax the completed form to 1.800.875.6591. 2. Create an account online at rxoutreach.org/how-to-enroll-in- rx-outreach/ 3. Call 1.888.RXO1234 (1.888.796.1234).

96 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 97

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/PODCAST 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 97 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® Astra Zeneca 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/

Bendamustine HCI 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

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

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

Dacomitinib Vizimpro® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

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

98 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 99 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® Astra Zeneca 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/

Bendamustine HCI 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

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

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

Dacomitinib Vizimpro® Pfizer 1-877-744-5675 www.pfizeroncologytogether.com/hcp

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

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 99 Quick Reference Guide

Drug Name Brand Name Drug Company Phone number Website 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#/ 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® Astra Zeneca 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® Astra Zeneca 1-844-275-2360 www.myaccess360.com Gefitinib Iressa® Astra Zeneca 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 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 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

100 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 101 Quick Reference Guide

Drug Name Brand Name Drug Company Phone number Website 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#/ 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® Astra Zeneca 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® Astra Zeneca 1-844-275-2360 www.myaccess360.com Gefitinib Iressa® Astra Zeneca 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 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 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

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 101 Quick Reference Guide

Drug Name Brand Name Drug Company Phone number Website 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™ Astra Zeneca 1-844-275-2360 www.myaccess360.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® Astra Zeneca 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® Astra Zeneca 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

102 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 103 Quick Reference Guide

Drug Name Brand Name Drug Company Phone number Website 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™ Astra Zeneca 1-844-275-2360 www.myaccess360.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® Astra Zeneca 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® Astra Zeneca 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

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 103 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 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 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

104 ASSOCIATION OF COMMUNITY CANCER CENTERS 2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 105 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 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 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

2020 PATIENT ASSISTANCE & REIMBURSEMENT GUIDE 105 A New ACCC Online Experience! Your accc-cancer.org experience is now more seamless, intuitive, and engaging!

You can now sign into our website, eLearning platform, and register for meetings with the same login information. Go to https://accc.force.com/login to start. Click on "Reset Password" to activate your account, then go to your "My Profile" page to update your personal information and indicate your Areas of Concentration. If your institution has strict firewalls, please provide your personal email address.

ACCCeXchange now has a new look! While things may feel a little different, we are pleased to continue to offer a virtual community for ACCC members to share knowledge, address tough questions, and get real-time feedback and solutions from colleagues. When logged in, navigate to "Groups" in the top right-hand corner of the page, then click on ACCCeXchange to share a post or ask a question.

Access multidisciplinary education and resources that support the delivery of quality cancer care. With a variety of flexible online formats that fit individual learning preferences, you can take your professional development to the next level through in-depth courses or gain quick knowledge in shorter learning formats. Get started at http://courses.accc-cancer.org/.

If you have any questions or feedback, please reach out to ACCC at [email protected]. A New ACCC Online Experience! Thank You to Our Supporters Your accc-cancer.org experience is now more seamless, intuitive, and engaging! INDUSTRY ADVISORY COUNCIL You can now sign into our website, eLearning platform, and register for meetings with the same login information. Go to https://accc.force.com/login to start. Click on "Reset Password" to activate your account, then go to your "My Profile" page to update your personal information and indicate your Areas of Concentration. If your institution has strict firewalls, please provide your personal email address.

EMERGING COMPANIES COUNCIL ACCCeXchange now has a new look! While things may feel a little different, we are pleased to continue to offer a virtual community for ACCC members to share knowledge, address tough questions, and get real-time feedback and solutions from colleagues. When logged in, navigate to "Groups" in the top right-hand corner of the page, then click on ACCCeXchange to share a post or ask a question.

TECHNICAL ADVISORY COUNCIL Access multidisciplinary education and resources that support the delivery of quality cancer care. With a variety of flexible online formats that fit individual learning preferences, you can take your professional development to the next level through in-depth courses or gain quick knowledge in shorter learning formats. Get started at http://courses.accc-cancer.org/.

If you have any questions or feedback, please reach out to ACCC at [email protected]. 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 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 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.

© 2020. Association of Community Cancer Centers. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means without written permission.

This publication is a benefit of ACCC membership.