Pomalyst

(pomalidomide)
Pomalyst 1 MG Oral CapsulePomalyst 2 MG Oral Capsule
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Dosage & administration

drug label

Pomalyst prescribing information

prior authorization

Pomalyst prior authorization resources

Most recent Pomalyst prior authorization forms

View By Payer
Verified: Feb 07, 2024Kaiser Foundation Health Plan - Chronic High-Dose Opioid Therapy Prior Authorization Form Washington
Verified: Feb 01, 2024Highmark BCBS Northeastern NY - Medical Injectable Specialty Drug Prior Authorization Form
Verified: Feb 01, 2024Highmark BCBS Northeastern NY - Outpatient Chemotherapy Prior Authorization Form (Medical Benefit)
Verified: Feb 01, 2024Highmark BCBS Northeastern NY - Specialty Drug Prior Authorization Form
Verified: Feb 01, 2024Highmark BCBS Northeastern NY - Non-Formulary Drug Coverage Prior Authorization Form

Most recent state uniform prior authorization forms

Verified: Jan 28, 2024Oregon - Uniform Prior Authorization Form
Verified: Jan 28, 2024Colorado - Uniform Prior Authorization Form
Verified: Jan 28, 2024Michigan - Uniform Prior Authorization Form
Verified: Jan 28, 2024Hawaii - Uniform Prior Authorization Form
Verified: Jan 28, 2024Minnesota - Uniform Prior Authorization Form
Verified: Jan 28, 2024New Hampshire - Uniform Prior Authorization Form
Verified: Jan 28, 2024New Mexico - Uniform Prior Authorization Form
Verified: Jan 28, 2024Texas - Uniform Prior Authorization Form
Verified: Jan 28, 2024Louisiana - Uniform Prior Authorization Form
Verified: Jan 28, 2024Arizona - Uniform Prior Authorization Form
Verified: Jan 28, 2024Indiana - Uniform Prior Authorization Form
Verified: Jan 28, 2024Illinois - Uniform Prior Authorization Form
Complete Letter of Medical Necessity
Coverage Authorization Appeals
Commercial Claim Denial Appeal/Redetermination Letter
Medically Unlikely Edit (MUE) Appeal Letter
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Benefits investigation

Pomalyst Enrollment Form
Pomalyst Enrollment Form - Spanish
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Reimbursement help (FRM)

Receive Assistance from an FRM Regarding Reimbursement Information
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pharmacy

Pomalyst preferred pharmacy

Pharmacy List

Financial Assistance

Financial Assistance Programs

Pomalyst retails for $1,151 per dose without insurance or financial assistance.Depending on your patient's insurance situation and other eligibility criteria, they may be able to get Pomalyst for significantly less. Review the program information below to determine what program can offer your patient the most benefits.
CoPay Card Program$0 Co Pay
Available for
commercial
Program Details
  • $1151 for Capsule
  • Program Expires Calendar Year
Forms
Pomalyst Enrollment Form
Pomalyst Enrollment Form - Spanish
Enroll in Patient Savings Program

PubMed™ | Pomalyst

Pomalyst PubMed™ News

patient education

Pomalyst patient education

To share resource; ask patient to:
1.Pull out phone
2.Open camera
3.Scan QR code with camera
4.Tap link

Patient toolkit

Getting My Medication Brochure: Multiple Myeloma
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
Lab Results Tracker: Multiple Myeloma
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
My Disease & Treatment Brochure: Multiple Myeloma
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
Caregiver Brochure: Multiple Myeloma
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
Conversion Starter: Multiple Myeloma
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
About Pomalyst: Multiple Myeloma
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
View How to Take Pomalyst: Multiple Myeloma
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
Side Effects: Multiple Myeloma
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
Patient Stories
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
Patient Resources: Multiple Myeloma
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
Other Patient Resources
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
About Pomalyst: Kaposi Sarcoma
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
Learn More

Other resources

REMS Companion App Download
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
Learn More

people also ask

Pomalyst FAQs

How is the dosage of Pomalyst?Pomalyst is available in 4 dosages, including 1 mg Cap, 2 mg Cap, 3 mg Cap and 4 mg Cap
What does Pomalyst treat?Pomalyst treats Multiple Myeloma
What is Pomalyst made of?Pomalyst contains pomalidomide which is a Thalidomide Analog
How Is Pomalyst Administered?Pomalyst is administered as a Oral Pill
FAQ Data Source