PAN: Chronic Lymphocytic Leukemia
Funded
About
The PAN: Chronic Lymphocytic Leukemia program is designed to provide comprehensive support for patients receiving treatment. Patients can benefit from a wide range of drug products, including Campath, Gazyva, Imbruvica, and others. The PAN: Chronic Lymphocytic Leukemia program ensures that eligible patients with health insurance can access necessary medications with ease, offering coverage for off-label drugs and financial assistance for up to 12 months.
Insurance requirements: Commercially insured, Medicare / Medicaid
Enrollment Forms
Enrollment Form
Benefits
•$2000 annual maximum benefit
Program Requirements
•Valid only for residents in the US and Puerto Rico
•Enrollment Required: Yes
•Coverage Required: No
•Needs Based: Yes
•Activation Required: No
Program Details
•Please note that this fund may cover offlabel drugs
•Patients can either call (18663167263) or apply through selfservice patient portal
•Provided patient completes application on self service portal or over the phone, eligibility determination takes less than one minute
•Portal/representative will provide enrollment dates, the patient's PAN I.D. number and the available grant balance, allowing for medications to be dispensed
•Patients will also receive approval letter and plastic pharmacy card within one week (provider will also receive letter)
•Assistance begins on approval date and continues for 12 months
•During initial eligibility period, eligible expenses incurred up to 90 days prior to approval date may also be submitted for reimbursement
•All eligible expenses must be submitted within 120 days of the eligibility end date
•Payment can be made to the patient, physician, pharmacy or health care provider
•Patients are eligible for renewal at the end of their eligibility period if funds are available
•Foundation will send a renewal application automatically if the program is accepting renewal patients
•Patient may apply for a second grant during their eligibility period subject to availability of funding
•Diagnosis Codes: ICD10: C83.00, C83.01, C83.02, C83.03, C83.04, C83.05, C83.06, C83.07, C83.08, C83.09, C91.10, C91.11, C91.12
Enrollment Forms
Enrollment Form