http://www.lls.org/#/diseaseinformation/getinformationsupport/financialmatters/copayassistance/
Co-Pay Assistance Program
The Leukemia & Lymphoma Society (LLS) Co-Pay Assistance Program helps you pay your insurance premiums and meet co-pay obligations. We'll also help you find additional sources of financial aid. The Co-Pay Assistance Program offers financial help toward:
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Blood cancer treatment-related co-payments
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Private health insurance premiums
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Medicare Part B, Medicare Plan D, Medicare Supplementary Health Insurance, Medicare Advantage premium, Medicaid Spend-down or co-pay obligations
You have complete freedom to choose doctors, providers, suppliers, insurance companies and treatment-related medications. You can make changes in any of the above at any time without affecting your continued eligibility.
Available Funding
Support for this program is based on the availability of funds by disease diagnosis. LLS Co-Pay Assistance funds are available for the following diagnoses:
- Chronic lymphocytic leukemia - assistance is available up to $2,500 (for applicants approved on or after 1/1/14)
- Chronic myeloid leukemia - assistance is available up to $1,000 (for applicants approved on or after 2/4/14)
- Hodgkin lymphoma - assistance is available up to $2,500 (for applicants approved on or after 1/1/14)
- Mantle cell lymphoma - assistance is available up to $5,000 (for applicants approved on or after 12/13/13)
- Myelodysplastic syndromes - assistance is available up to $5,000
- Myeloma - assistance is available up to $10,000
- Non-Hodgkin lymphoma - assistance is available up to $2,500 (for applicants approved on or after 1/1/14)
Please check this page regularly for funding updates. We are actively seeking sponsorship for other blood cancers not funded by this program. Call an LLS Information Specialist at (800) ■■■■■■■■ for assistance if you're uncertain about the coverage of any diagnosis.
Eligibility Requirements
To be eligible for Co-Pay Assistance, you must
- Have a household income that is at or below 500 percent of the U.S. federal poverty guidelines as adjusted by the Cost of Living Index (COLI).
- Be a United States citizen or permanent resident of the U.S. or Puerto Rico and be medically and financially qualified
- Have prescription insurance coverage
- Have an LLS Co-Pay Assistance Program-covered blood cancer diagnosis confirmed by a doctor (see covered diagnoses listed above)
Covered Expenses
Click here for a list of covered and non-covered expenses.
How to Apply
Online: Patients, caregivers, pharmacies and healthcare providers can easily submit online Co-Pay applications with a quick registration process, day or night. Your doctor, treatment provider or pharmacy can also apply for the program on your behalf.
- Patients and Caregivers: Submit an application now
- Pharmacies and Healthcare Providers: Submit a patient application now
Patients and providers may apply for assistance and check the status of submitted applications and claims 24 hours a day via the online portal.
By Phone: You may apply or get more information about the Co-Pay Assistance Program by calling (877) ■■■■■■■■ to speak with a Co-Pay Specialist who will provide personalized service throughout your application process.
By Email: You may email your request for a Co-Pay Specialist to contact you about the program at ■■■■■■■■■■■■■.
Required Information
The Co-Pay Assistance Program application requires information to be completed and signed by both you and your doctor. You must also submit documentation verifying household income. All documentation will be kept confidential and is used solely for approval into the program. You may upload your documentation using the online portal. If you prefer to mail or fax your application, send the forms and supporting documents to:
| The Leukemia & Lymphoma Society Co-Pay Assistance Program P.O. Box 12268 Newport News, VA 23612 Toll Free: (877) ■■■■■■■■ Fax: (877)-COPAY-FAX or (877) ■■■■■■■■ |
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