NORD: Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN) (Copay)

Funded

About

The NORD: Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN) Co-Pay Program provides financial support for patients needing Cyclophosphamide, Cotellic, or Elzonris. The program offers an array of services including Co-Pay, Emergency Relief, and Travel & Lodging Assistance, particularly for those diagnosed with BPDCN. NORD ensures quick approval and streamlined application processes, making treatment more accessible for patients in need.

Insurance requirements: Commercially insured, Medicare / Medicaid

Enrollment Forms

Enrollment Form

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 the following:

•1. Program offers CoPay, Emergency Relief, and Travel & Lodging Assistance Programs

•2. Specific drug coverage is not indicated on program website; drug coverage must be verified by calling program

•3. Specialty Pharmacy representatives/case managers can send new referrals through the referral portal (https://rareaccess.org/#/login). Representatives must be preregistered by sending a request to RareAccess@rarediseases.org. Representatives can also email the program email address. To make the problem resolution quicker and more efficient please do not send messages to individual emails. If the matter is URGENT, please reach out to SP account manager for NORD to escalate the issue

•Patients may apply online, call (2036352644) or email (BPDCN@rarediseases.org) program to enroll

•Awards are made for a calendar year, and patients may reapply for subsequent years

•NORD is able to offer same day approval for programs

•Patients must undergo a financial evaluation of need, and provide HIPPA authorization and accept a waiver of liability

•Fax number is 2034058178

Enrollment Forms

Enrollment Form