Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  

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Aliqopa Resource Connections (ARC)

For Healthcare Professionals Only

Provided by: Bayer HealthCare Pharmaceuticals Inc.

PO Box 220694
Charlotte, NC 28222

TEL: 833-254-7672

FAX: 833-427-2329
Languages Spoken:



Program Applications and Forms

Aliqopa Resource Connections (ARC) Patient Assistnace Program Form

Aliqopa Resource Connections (ARC) Administering Providers Enrollment Form



  • Aliqopa (copanlisib)

Eligibility Requirements   

Insurance Status Must be uninsured or underinsured
Those with Part D Eligible? Contact program for details.
Income Not disclosed
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Must be residing in the US or a US territory, and under the care of a US physician


Obtaining Call or download
Receiving Faxed or downloaded from website
Returning Fax from Doctor's office
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Inform Doctor that he/she is in need
Decision Communicated Doctor notified
Decision Timeframe Within 1-2 business days


Amount/Supply 1 dose
Sent To Doctor's office or specific site
Delivery Time Varies
Refill Process Doctor/Doctor's office must contact the Program
Limit Only limited by manufacturer's guidelines
Re-application This is a one time program

Additional Information


This program also provides co-pay and reimbursement assistance.

Updated November 14, 2017