Drug Reimbursement Hotlines/Patient Assistance Programs

Allos Support for Assisting Patients
ASAP
Monday–Friday, 9:00 am–6:00 pm, ET
Phone: 1.877.ASAP102 (877.272.7102)
Fax: 1.877.801.0777

Allos Therapeutics, Inc. proudly sponsors the Allos Support for Assisting Patients (ASAP) program, a reimbursement support and patient assistance program designed to help patients and healthcare professionals gain appropriate access to FOLOTYN® (pralatrexate injection). The ASAP program provides the following services:

• Verification of Patient-Specific Insurance Benefits
• Pre-Submission Claims Review and Support
• Prior Authorization Assistance
• Coding and Billing Guidance
• Payer Research
• Denied and Underpaid Claims Assistance
• Patient Assistance Program for Qualified Patients

Allos Therapeutics, Inc. does not guarantee coverage and/or reimbursement for FOLOTYN. Coverage, coding, and reimbursement policies vary significantly by payer, patient, and setting of care. Actual coverage and reimbursement decisions are made by individual payers following the receipt of claims. Allos strongly recommends verifying coverage, coding, and reimbursement guidelines on a payer and patient-specific basis.

Amgen Assist™

888.427.7478
Fax: 888.407.9787
Monday through Friday from 9 am to 8 pm ET

Mailing Address:
Amgen Assist
PO Box 220354
Charlotte, NC 28222-0354

Amgen Assist Online gives patients and healthcare providers a single destination for access to online services and forms, and makes it easier to find a program that would best meet each patient's unique needs.

• Insurance verification
• Prior authorization
• Billing and claims processing support and tracking
• Policy and program updates

Access our online eService by logging in above or clicking Register Now if you have not previously registered with Amgen Assist. You can also call Amgen Assist and speak with an Amgen Reimbursement Counselor specific to your region for support with reimbursement or patient assistance.

AZ&Me Prescription Savings Program
Monday–Friday, 9:00 am–8:00 pm ET
1.866.992.9276

You may qualify for one of the AZ&Me Prescription Savings Programs. Click to find out, or call 1.800.292.6363.

REACH® - Resources for Expert Assistance and Care Helpline
Monday–Friday, 9 am–8 pm, EST
1.866 NEXAVAR (1.866.639.2827)

The REACH® program assists patients in getting started with Nexavar® (sorafenib) tablets. Nexavar is distributed through designated specialty pharmacy providers (SPPs); it is not available through retail pharmacies. A REACH program counselor will identify an SPP that will fill the Nexavar prescription and send it directly to the patient's home. A REACH program counselor will also call patients to provide help in understanding insurance coverage and the Medicare Part D drug benefit and aid in finding other sources of payment for Nexavar. The Reimbursement Support Line Team has experience with all payer types, including Medicare. Questions answered by the team typically can be classified into one of the following groups:

• Benefit verification
• Coding assistance and billing instruction
• Claims review
• Claims-appeal assistance
• Prior-authorization assistance
• Patient assistance.

In addition, Bayer HealthCare Pharmaceuticals offers a patient assistance program that provides treatment to uninsured patients who meet the program requirements.

BI Cares Foundation
1.800.556.8317

To learn more about the BI patient assistance programs, please call the number above or apply online at www.RxHope.com.

Destination Access
Monday–Friday, 9:300 am–6:00 pm, EST
800.861.0048

This program was created to improve access to care for cancer patients receiving Bristol-Myers Squibb oncology products and to help community-based oncologists secure payment for patients’ medicine within payer guidelines. Destination Access provides appeals assistance including: guidance on payer-specific appeals process, denied prior authorization assistance; provision of template appeals letters, appropriate literature, and local coverage determination information. Destination Access offers a current library of peer-reviewed journals maintained by a staff research analyst, providing supporting clinical evidence to patients and physicians for facilitation of payment decisions.

Upon receipt of a signed authorization, Destination Access can also investigate a patient’s available benefits including determination of co-pay, coinsurance, and deductible amounts; investigation of primary, secondary, and other policies; and investigation of Medicaid, state senior programs, Veterans Administration benefits, co-pay foundations, and other potential resources.

To be considered for free Bristol-Myers Squibb Oncology products, Destination Access will use the following guidelines to evaluate patients who:

• Meet certain financial eligibility criteria
• are U.S. citizens or legal residents
• Are receiving treatment in the U.S. on an outpatient basis, and have no insurance assistance.

Patient Support Coordinator (PSC) Program
Monday–Friday, 8 am–7 pm, EST
Phone: 800.931.8691
Email: patientsupport@celgene.com

Patient Support Coordinator®
This program offers a dedicated central point of contact to assist providers and cancer patients navigate the challenges of reimbursement, provide information about co-pay assistance, and answer general questions about Celgene products and their distribution.

The Patient Support Coordinator assists cancer patients with:

• Reimbursement assistance, insurance claims, and appeals
• Medicare Part D prescription drug benefit issues
• Locating co-pay assistance programs and services
• Identifying pharmacies that are registered to dispense Celgene products
• Determining the status of a prescription
• Inquiries regarding Celgene's patient assistance program
• Information regarding Celgene products and their restricted distribution programs (RevAssist® or S.T.E.P.S.®) or appropriate contacts for other questions.

PROCRITline.com Reimbursement Hotline for Procrit®
PROCRITline.com This website provides easy access to reimbursement information and support including:

• Benefit verification
• Prior authorization
• Appeal process and procedure research
• Alternate source of payment
• General billing and coding questions
• Information regarding patient assistance.

Centocor Ortho Biotech will provide assistance to certain eligible Procrit® (epoetin alfa) and Leustatin® (cladribine) Injection patients at no charge, based on medical and financial need. For more information, call the toll-free PROCRITline at 800.553.3851. Representatives are available Monday through Friday from 8 am to 8 pm EST to answer questions from patients and healthcare providers. Inquiries can also be faxed to: 800.987.5572.

The toll-free hotline is convenient and easy to use. When calling about a patient’s specific reimbursement issues, please have the following information available. Patients must authorize disclosure of this information:

• The patient’s information
• The name and telephone number of the patient’s insurance plan(s), policy numbers(s), and the name of the subscriber
• Physician’s name, address, and telephone number
• Patient’s financial information if calling on behalf of an uninsured patient.

Reimbursement Hotline for DOXIL®
(doxorubicin HCI liposome injection) Doxiline
Monday–Friday, 9 am–8 pm, EST
Phone: 800.609.1083
Fax: 800.987.5572

This website provides easy access to reimbursement information and support,* including:

• Benefit verification
• Prior authorization
• Appeal processes and procedure research
• Alternate sources of payment
• General billing and coding assistance
• Information regarding patient assistance.

Centocor Ortho Biotech will provide assistance to certain eligible Doxil® (doxorubicin HCl liposome injection) patients at no charge, based on medical and financial need. For more information, call the toll-free line at 800.609.1083. Representatives are available Monday through Friday from 8 am to 8 pm EST to answer questions from patients and healthcare providers. Inquiries can also be faxed to: 800.987.5572.

The toll-free hotline is convenient and easy to use. When calling about a patient’s specific reimbursement issues, please have the following information available. Patients must authorize disclosure of this information:

• The patient's information
• The name and telephone number of the patient's insurance plan(s), policy numbers(s), and the name of the subscriber
• Physician's name, address, and telephone number
• Patient's financial information if calling on behalf of an uninsured patient.

*The information provided represents no statement, promise, or guarantee by Centocor Ortho Biotech Products, Inc. concerning levels of reimbursement, payment, or charge. Please consult your payer organization with regarding local or actual coverage and reimbursement policies and determination processes.

Cephalon supports patients and healthcare providers through programs for eligible patients treated in the United States who do not have insurance, cannot afford their out-of-pocket co-pay costs, or need assistance with reimbursement issues. Cephalon Oncology’s support program is designed to help patients and healthcare providers navigate the reimbursement landscape with resources aimed at clarifying issues and assisting with the claims process. Specific assistance includes the following:

• Benefit verification and coverage
• Policy benefits and limitations
• Personalized support through the claims process
• Appeal support.

In addition, Cephalon offers a patient assistance program to provide FDA-approved products free of charge for patients who qualify.

Cephalon also engages with groups like the Leukemia and Lymphoma Society that have programs designed to help patients access the treatments they need.

For additional information, contact Cephalon’s Oncology Reimbursement Expertise Support Hotline at 888.587.3263.

Cephalon CORE Program:

• CORE Hotline
  Phone: 1.888.587.3263
  Fax: 1.866.676.4073
  Address:
  6900 College Blvd., Ste. 1000
  Overland Park, KS 66211

CORE website: CephalonOncologyCORE.com

CORE is a convenient reimbursement resource that provides a support program along with online tools to help physicians and patients better understand the reimbursement process.

To get personalized support when submitting reimbursement claims for Treanda®, physicians can contact the toll-free hotline at: 1.888.5.TREANDA (1.888.587.3263). Treanda reimbursement counselors are available by phone Monday through Friday, from 9 am to 8 pm EST. These trained experts can help with the following:

• Benefit verification and coverage information
• Policy benefit design
• Pre-certifications/prior authorization support
• Coverage guidelines and claim requirements
• Personalized support through the claims process
• Templates for letters of medical necessity
• Appeal support
• Treanda Patient Assistance Program.

When calling about patient-specific reimbursement issues, it may be necessary to have the following available:
Patient's name, address, and phone number; Date of birth; Social Security number; Plan name; Plan policy number; Physician’s name, address, and phone number; Date of service; Drug name; Dosin; Treatment schedule; Income level (if Patient Assistance applicant).

To initiate reimbursement support services, such as benefit investigations, prior authorizations, appeals support, and/or patient assistance, physicians must download the updated Patient and Physician Enrollment Form.

The Eisai Assistance Program
Monday–Friday, 8:00 am–8:00 pm ET
1.866.613.4724

Click to find out more.

Lilly PatientOne
Monday–Friday, 9 am–7 pm EST
1.866.472.8663, option 1 (1.866.4PatOne, option 1)

Recognizing that medical insurance issues for oncology patients are numerous and often complex, Eli Lilly and Company provides medical professionals, on behalf of their patients, with access to current reimbursement information and support programs for Lilly Oncology products. To assist patients, physicians, and office staff, program administrators offer the following support:

• Information: Support related to clinical documentation, benefits verification, coding guidance, and reimbursement advice.
• Insured Patients: Help with filing paperwork, reimbursement assistance, and complete service on appeals for denied claims.
• Underinsured Patients: Counseling on programs that may help fund patient co-pay, and benefit verification statements.
• Uninsured Patients: Product assistance for patients who qualify.

Lilly provides multiple ways to apply for reimbursement assistance. Cancer patients and providers can call the PatientOne Hotline at: 866.4PatOne (866.472.8663) Monday through Friday from 9 am to 7 pm EST. The PatientOne Application Form is also available online at: www.lillypatientone.com.

Genentech Access to Care Foundation (Avastin, Herceptin, Rituxan, Tarceva, Xeloda)
1 DNA Way, MS-857A
South San Francisco, CA 94080-4918
1.800.530.3083
1.877.428.2326 (fax)

How to Apply: Click on the link above to download the application or go to the program web site for more information on how to apply. Once you fill out your application, send it to the address on the application.

Eligibility: The Genentech® Access to Care Foundation (GATCF) was created to help qualified patients with unmet medical needs who are uninsured or who have been denied coverage by their health plans to obtain therapy. Therefore, patients who have no insurance or their health plan has denied coverage for treatments can apply to GATCF to receive their medicine free of charge.

Patients: Your healthcare provider will work with Genentech Access To Care Foundation to complete the application process. Hospital/facility must complete Genentech Access To Care Foundation Statement of Medical Necessity Form. Patients must complete the Patient Authorization and Notice of Release of Information form and also provide proof of income. The medication is sent to the doctor's office, hospital, or pharmacy.

Genomic Health Customer Service
Monday through Friday, 5:30 AM to 5:00 PM PT
Tel: (866) ONCOTYPE (866-662-6897)

Ordering Oncotype DX and the Genomic Access Program (GAP)

Genomic Health has established the Genomic Access Program (GAP) to provide financial and administrative support to patients ordering the Oncotype DX assay. The GAP program was established to assist qualified patients to gain access to Oncotype DX and to help patients and physicians with the entire reimbursement process.

GAP is made up of dedicated professionals who advocate on a patient’s behalf by working with physicians’ offices and insurance companies to facilitate access to Oncotype DX. In addition, GAP provides various comprehensive financial assistance programs for patients with financial hardship, uninsured patients, and underinsured patients based on eligibility.

While GAP directly supports the patient, it also works with physicians’ offices to provide individualized assistance and support with every claim. GAP services are available at physician or patient request, do not require pre-registration, and can be accessed at any time before, during, or after you have ordered the Oncotype DX assay.

Genomic Health is prepared to bill insurance plans directly on behalf of insured patients in the U.S. whose physician orders an Oncotype DX assay. Genomic Health is pleased that, to date, the Oncotype DX Breast Cancer Assay has extensive reimbursement for over 90 percent of privately insured lives in the United States and Medicare beneficiaries.

Through GAP, the patient’s physician can request a Benefits Investigation to confirm whether the patient’s insurance plan is active and obtain available benefits information specific for Oncotype DX. Some insurers require a prior authorization before processing the patient’s specimen; the GAP team can also help facilitate this process.

In the event that a payer denies an Oncotype DX claim, GAP representatives will identify the reasons and advocate on the patient’s behalf. This practice may require the physician’s office to provide specific medical records necessary to file an appeal.

GAP representatives are available to answer further questions and help you with ordering the Oncotype DX assay. For assistance, please call 866.ONCOTYPE (866.662.6897). For additional information, visit www.OncotypeDX.com.

Genzyme Direct Response Program

This comprehensive collection of support services helps patients and providers with product ordering, adverse event reporting, clinical trial information, and reimbursement and patient assistance:

• Campath: 1.877.422.4CAMPATH (1.877.422.6728)
• Leukine: 1.888.4RX.LEUKINE (1.888.479.5385)
• Clolar: 1.800.RX.CLOLAR (1.800.792.5652)
• Fludara: 1.888.4FLUDARA (1.888.435.8327)
• Mozobil: 1.877.4Mozobil (1.877.466.9624).

Call the numbers above specific to each product for the services listed below:

• Product ordering. For next-day air delivery—select Option 1.
• Adverse event reporting. To report an adverse event (infusion-related or otherwise)—select Option 2.
• Medical information. For medical information including clinical trial information—select Option 2.
• Reimbursement assistance. For access to specialists with expertise in public and private health insurance—select Option 3.
• Patient assistance programs. To learn more about access to treatment for qualified patients who are uninsured and lack financial means—select Option 3.

GSK Commitment to Access Program
Monday–Friday, 9 am– 6 pm, ET
Phone: 800.745.2967 or 800.699.3806
Fax: 866.216.5292

CARES by GSK

GlaxoSmithKline is committed to helping patients gain access to our medications. We understand that the healthcare insurance system is often complex and confusing. The CARES by GSK program provides a variety of services to help patients and healthcare providers navigate this system. Benefits to enrolled patients include:

• Insurance coverage and benefits verification
• Enhanced delivery of medications
• Research into alternative funding options
• Patient connection to assistance programs

To enroll, complete an online application.

The ACT Program
1.866.363.6379

This program provides free reimbursement support services to help answer questions related to insurance coverage and reimbursement.

VELCADE® Reimbursement Assistance Program
Monday–Friday, 9 am–7 pm, EST
866.VELCADE
866.835.2233

The VELCADE Reimbursement Assistance Program is a full-service hotline for health care providers, patients and caregivers. Reimbursement Specialists can verify health insurance coverage and eligibility; obtain pre-authorization; assess each patient’s drug coverage; and clarify any co-payment obligations patients may have relative to VELCADE® (bortezomib) for Injection. In addition, coding and billing questions can be discussed with Reimbursement Specialists to facilitate appropriate payment for VELCADE and related services.

In cases where patients have insufficient health insurance coverage, Reimbursement Specialists will help determine if alternative funding sources for VELCADE are available. If no other sources of drug coverage can be identified, patients will be evaluated for the VELCADE Patient Assistance Program and if eligible, will receive VELCADE free of charge.

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Patient Assistance and Reimbursement Programs

Reimbursement Hotline: 800.282.7630
Patient Assistance Programs: 1.800.277.2254

Novartis is committed to providing access to our medications for those most in need. Through a variety of resources, including the Novartis Oncology Patient Assistance Program, the Novartis Oncology Reimbursement Hotline, and our support of independent Charitable Copay foundations, we have made a firm commitment to enable patients in need to access medicines.

Visit www.novartisoncology.us for complete patient assistance, reimbursement, and clinical trail information.

Oncology Reimbursement Assistance Program: Pfizer Helpful Answers
Monday–Friday, 9:00 am–8:00 pm, EST
Phone: 1.866.706.2400

PACT+

Patient Assistance and Reimbursement Services

PACT+ is the reimbursement and product support program sponsored by sanofi-aventis that helps providers and patients access sanofi-aventis oncology products. Assistance offered by PACT+ includes:

• Reimbursement services: Benefit verification and prior authorization; Claims management; Appeals assistance
• Patient assistance program (PAP and drug replacement)
• Alternative services: Referrals to alternative support services such as co-pay assistance, cancer advocacy group support, other drug assistance programs, medical supplies and devices, cosmetic aids, utilities, transportation services, etc.

PACT+ eligibility criteria include:

• Submission of completed PACT+ application packet—signed by physician and patient.
• Patient meets financial eligibility criteria (household income of < 500% FPL). (Proof of income is required.)
• Patient must be a U.S. citizen or legal resident of the United States.

PACT+ Provider Portal

The PACT+ Provider Portal is a secure website accessible only to healthcare providers and reimbursement personnel who participate in the PACT+ program on behalf of needy patients. The provider portal offers improved workflow processes related to reimbursement and patient assistance program information, such as:

• Online application submission
• Secure messaging
• PAP product shipment tracking
• Centralized patient-related information, including patient history, alerts/reminders, insurance benefit summaries, attachments, and case history.

All PACT+ services are available anytime through www.pactplusonline.com and reimbursement counselors are available at 800.996.6626 Monday through Friday from 9 am to 8 pm EST.

Reimbursement Assistance and Patient Assistance

TopoTarget is committed to supporting healthcare providers navigate the reimbursement landscape with assistance with the claim and appeal process, should one exist. For more information on reimbursement support, please call 877.456.4017.

Provider and Patient Education

Totect® Medical Hotline Totect is the first drug to gain approval from the FDA for the treatment of AEV. In addition, Totect has been granted orphan drug status by the FDA.

TopoTarget continues to provide unrestricted grants to the oncology healthcare community to help create awareness and prevention of AEV. In addition, in-service programs are recommended and performed when a treatment kit is purchased to alert staff of early detection and treatment should an AEV occur.

TopoTarget provides a Totect Medical Hotline staffed 24 hours a day, 7 days a week. If you have questions regarding Totect, please call 877.456.4017.