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:

English

 

Program Applications and Forms

Aliqopa Resource Connections (ARC) Patient Assistnace 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 November 14, 2017