COPAY ASSISTANCE REGISTRATION
COPAY ASSISTANCE VERIFICATION
COPAY ASSISTANCE CODE

Upon completing your application, submit for review.Log on to the LLS Financial Assistance Copay Portal using newly created password.Receive confirmation email (typically within 5 minutes of submitting) and click on the link provided to create a password.

COPAY ASSISTANCE REGISTRATION

Complete the registration form in the LLS Financial Assistance Copay Portal and submit.

If this is your first time visiting the LLS Financial Assistance Copay Portal, you will need to register before you can start the online application. If you do not have an LLS Financial Assistance Copay Portal Account: Note: There is a separate portal for all other Patient Financial Assistance Programs LLS offers patients, caregivers, pharmacies, and healthcare providers two easy ways to register/apply:

COPAY ASSISTANCE VERIFICATION

In the event that you are unable to get your doctor to sign off on the Diagnosis Verification Form for your application, we will accept a portion of your electronic medical record (EMR) or other documentation that shows the diagnosis/ICD-10 code. *Healthcare Professionals (HCP) applying on behalf of a patient will be asked for their NPI and tax ID. This information will not be shared and is for verification purposes only. The name of treating physician and their phone/fax numbers.The name of your pharmacy and its phone/fax numbers.Insurance card, as well as Medicare/Medicaid.If the patient is a minor, you will need a guardian Social Security number as well.The patient's demographic information (including their Social Security number and date of birth) and their contact information.STEP 1: Gather the following information. If you prefer to apply on your own, please refer to the information below. You may call (877) 557-2672 to speak with an Intake Specialist who can walk you through the application process. The patient must be in active treatment, scheduled to begin treatment, or is being monitored by their doctor.Have a blood cancer diagnosis confirmed by a doctor.

COPAY ASSISTANCE CODE

federal poverty guidelines as adjusted by the Cost of Living Index (COLI). You will be asked for your zip code to determine your COLI. Have a household income that is at or below 600 percent of the U.S.Be a United States citizen or permanent resident and reside in the U.S.To be eligible for Co-Pay Assistance, you must Please visit our website in the future to become aware of new funding. Program continuation is dependent on the availability of funds and the program could be modified or discontinued at any time if funding is limited or no longer available. Renewal patients are those who have received assistance through our program in the past and continue to reapply.Īs a non-profit organization, we rely on the generosity of our sponsors. *Philadelphia Chromosome Negative Myeloproliferative Neoplasms only.Ī fund that is “fully subscribed” is at maximum capacity, serving those enrolled, and is not enrolling additional patients (new or renewal patients).

Plasma cell leukemia or plasma cell myeloma.

Juvenile myelomonocytic leukemia (JMML) (diagnosis formerly known as chronic myelomonocytic leukemia of infancy ).

Please refer to our booklet, Non-Hodgkin Lymphoma, for additional subtypes ( click here).

Post-transplant lymphoproliferative disorder or PTLD.

T-cell large granular lymphocytic leukemia (LGL).

Statusįully subscribed and closed to enrollment If you started an application prior to a fund becoming fully subscribed, please continue with the application. For up-to-the-minute fund status, please call (877) 557-2672. Please note: Changes to funds are reflected on this webpage as quickly as possible. These campaigns support LLS’ patient education, support services, advocacy, and research.

The Trish Greene Back to School Programįunding for the Co-Pay program is provided by pharmaceutical and biotech companies and is not supported by other sources of revenue including our fundraising campaigns such as Team In Training, Light The Night, Student Series, Leukemia Cup Regatta, Man & Woman of the Year, or Student of the Year.

Copay assistance