Valchlor

(mechlorethamine)
mechlorethamine 0.00016 MG/MG Topical Gel [Valchlor]
NO BLACK BOX WARNING

Dosage & administration

drug label

Valchlor prescribing information

Have more Valchlor questions?

Submit MSL Request
Learn More

Need to report a Valchlor issue?

ONLINE FORM
Report adverse event
Learn More

samples

Request Valchlor samples

NOT PROVIDED BY BRAND
View Online Sample Form
Learn More

prior authorization

Valchlor Prior authorization resources

NOT PROVIDED BY BRAND
Complete Letter of Medical Necessity

NOT PROVIDED BY BRAND
Coverage Authorization Request

NOT PROVIDED BY BRAND
Coverage Authorization Appeals
Learn More

Benefits investigation

Valchlor Patient Intake and Prescription Form
Learn More

Reimbursement help (FRM)

NOT PROVIDED BY BRAND
Reimbursement help (FRM) resources
Learn More

financial assistance

Valchlor Financial assistance options

Co-pay savings program

commercial only
Valchlor Patient Intake and Prescription Form
Enroll in Patient Savings Program
Learn More

Bridge program

commercial only
Learn More

Foundation programs

under insured
no insurance
goverment insurance
65+
Learn More

patient education

Valchlor Patient education

Getting started on Valchlor

Instructions For Use: Mycosis Fungoides-type Cutaneous T-cell Lymphoma (MF-CTCL)
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link

Patient toolkit

Patient Brochure
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
How To Store Valchlor
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
Patient Resources
ASK PATIENT TO:
Open Camera on Phone
Scan QR Code & Tap Link
Learn More

Can't find what you're looking for?

Our trained staff can help you:
Please note:
  • Access to a Field Reimbursement Manager (FRM) or Medical Science Liaison (MSL) varies by brand and may require talking with your rep first.
  • Samples are provided at the discretion of the brand.
  • We are unable to collect Protected Health Information (PHI), fill out forms, or submit them on your behalf.