Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 2.
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Updated December 12, 2014
 

Fusilev

Spectrum Therapy Access Resources (STAR) Program

This program provides brand name medications at no or low cost.

Provided by: Spectrum Pharmaceuticals, Inc.

PO Box 220551
Charlotte, NC 28222-0551

TEL: 888-537-8277


ALT PHONE:
FAX: 866-930-1562
Languages Spoken:

English, Others By Translation Service

 

Patient Assistance Applications

STAR Patient Enrollment Form

STAR Patient Enrollment Form for Beleodaq

 

Medications

  • FUSILEV For Injection dosage varies (levoleucovorin)
 

Eligibility Requirements   

Insurance Status Must be uninsured or underinsured
Those with Part D Eligible? No
Income Not disclosed
Diagnosis/Medical Criteria Medication must be for outpatient use only
US Residency Required? Must be US citizen or permanent resident
   

Application

Obtaining Call or download
Receiving Faxed, mailed or downloaded from website
Returning Fax or mail
Doctor's Action Complete section and sign
Applicant's Action Complete section, sign, attach insurance information
Decision Communicated Doctor notified
Decision Timeframe Within 24-48 hours
   

Medication

Amount/Supply Varies
Sent To Doctor's office
Delivery Time Within 3-5 business days
Refill Process Doctor's office must contact the company
Limit None
Re-application New application every 6 months
   

Additional Information

Insurance benefits, claims assistance,/or other reimbursement help is offered.


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 2. Updated October 17, 2014
 

Fusilev

Patient Access Network Foundation (PAN)

This is a copay assistance program.

Provided by: Patient Access Network Foundation

PO Box 221858
Charlotte, NC 28222-1858

TEL: 866-316-7263


ALT PHONE:
FAX: 866-316-7261
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Patient Assistance Applications

PAN Brochure

PAN Eligibility Criteria and Benefit Cap Information

PAN Proof of Expenditure Form

 

Medications

  • FUSILEV Injection 50mg, 175mg/17.5mL, 250mg/25mL (levoleucovorin calcium)
 

Eligibility Requirements   

Insurance Status Must have insurance
Those with Part D Eligible? Determined case by case
Income At or below 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 Sent out or may be completed online
Returning Fax, mail or submit online
Doctor's Action Will be discussed with patient and Doctor after request is received
Applicant's Action Complete section and sign
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

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.