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

Alunbrig 1Point

This program provides brand name medications at no or low cost

Provided by: Takeda Oncology

11800 Weston Parkway
Cary, NC 27513

TEL: 844-217-6468


FAX: 855-246-5197
Languages Spoken:

English

Program Website

 

Patient Assistance Applications

Alunbrig 1Point Enrollment Form

Alunbrig 1Point Patient Assistance Program Application

 

Brand Name Medications Covered

 
  • Alunbrig
 

Generic Name

 
  • brigatinib
 

Eligibility Requirements   

Insurance Status *Contact program for details.
Those with Part D Eligible? No
Income Not disclosed
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Not specified
   

Application

Obtaining Call or download
Receiving Faxed or downloaded from website
Returning *See Additional Information section below
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Patient and Doctor are notified
Decision Timeframe 2-3 business days
   

Medication

Amount/Supply Up to 1 month supply
Sent To Patient's home, unless otherwise noted
Delivery Time Not specified
Refill Process Doctor/Doctor's office must contact the Program
Limit One year
Re-application Maximum is one year
   

Additional Information

*The physician must submit the ALUNBRIG 1Point Enrollment Form before applying for the Patient Assistance Program.

This program also provides copay assistance.


Updated August 22, 2017