Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
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Patient Access Network Foundation (PAN)

This is a copay assistance program

Provided by: Patient Access Network Foundation


TEL: 866-316-7263


FAX: 866-316-7261
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

Patient Access Network Foundation (PAN) Application: Contact program

 

Medications

  • Aliqopa (copanlisib)
 

Eligibility Requirements   

Insurance Status *See Additional Information section below
Those with Part D Eligible? Determined case by case
Income Between 400-500% of FPL
Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
US Residency Required? Must reside and receive treatment in US
   

Application

Obtaining Call or complete online
Receiving Complete online or by phone
Returning Complete online or by phone
Doctor's Action Will be discussed with patient and Doctor after request is received
Applicant's Action Call for information or inform doctor that he/she is in need
Decision Communicated Patient and Doctor notified in writing
Decision Timeframe Within 48 hours
   

Medication

Amount/Supply Not applicable
Sent To Patient sent card to be used at pharmacy
Delivery Time Once approved; shipped same day
Refill Process Patient presents voucher/card to pharmacy for each refill
Limit None
Re-application New application every 12 months
   

Additional Information

*Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance.

Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly.

Note: All new enrollment is now done electronically or over the phone. Contact program for details.


Updated July 10, 2018


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 2.
 

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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:

English

Program Website

 

Program Applications and Forms

Aliqopa Resource Connections (ARC) Patient Assistance Program Form

Aliqopa Resource Connections (ARC) Administering Providers Enrollment Form

 

Medications

  • 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
   

Application

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
   

Medication

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

Resources for HEALTHCARE PROFESSIONALS ONLY.

This program also provides co-pay and reimbursement assistance.


Updated April 11, 2018