Getting Started
Your patient has 2 options to enroll. They can either download and print the form to fill out with you, or they can initiate their enrollment online. In either case, you will be responsible for signing and submitting the form via fax or email along with a copy of the patient’s insurance card and prescription.
Patients will be required to enroll in Takeda Oncology Here2Assist to determine which financial assistance programs they are eligible for based on their insurance, including the Takeda Oncology Patient Assistance Program. To learn more, we encourage your patients to call a Case Manager to learn more about the program at: 1-844-817-6468.
Please note your patient does not need to be enrolled in Takeda Oncology Here2Assist to access the Takeda Oncology Co-Pay Assistance Program. They can enroll by visiting takedaoncologycopay.com. Terms and Conditions apply.*
Coverage
Our Case Managers are available to assist you if your patient’s insurance issues a denial of coverage. We will review the reasons behind the denial and provide you with information to move forward with the appeal process. You can find a sample letter of appeal below to get started.
We understand the challenges that come with helping uninsured patients gain access to their medication. If your patient is uninsured or the prescribed medication is not covered, the Takeda Oncology Patient Assistance Program may be able to provide eligible patients with a 1-month supply of ICLUSIG® (ponatinib) at no cost to them. Patients must meet certain financial and insurance coverage criteria to be eligible.
Patients must enroll in Takeda Oncology Here2Assist before applying for the Takeda Oncology Patient Assistance Program. You can enroll online or download and print an Enrollment Form and fill it out together with your patient. A Case Manager will review the Enrollment Form and notify both you and your patient if they are eligible for the Takeda Oncology Here2Assist program and available services.
Both specialty pharmacies and in-office dispensing options may be different based on your patient’s specific medication. When searching for distribution options, you will be prompted to choose your patient’s product first.
Additional Support
Our Case Managers will work with you and your patient to help them access their Takeda Oncology medication. When you call us, a regionally specific Case Manager will speak with you about which resources may be right for your patient, no matter where they are in their Takeda Oncology treatment journey.
You or your patient can call 1-844-817-6468, Option 2, to speak with a Case Manager. We’re available Monday-Friday, 8AM-8PM ET.
Call 1-844-817-6468, Option 2, to speak with a Case Manager. We’re available Monday-Friday, 8AM-8PM ET.
*By enrolling in the Takeda Oncology Co-Pay Assistance Program (the “Program”), you acknowledge that you currently meet the eligibility criteria and will comply with the following terms and conditions:
You must be at least 18 years old, a resident of the United States or a US Territory, and have commercial (private) prescription insurance that does not cover the entire cost of the Takeda Oncology medication. The Program is not valid for patients whose prescription claims for the Takeda Oncology medication are eligible to be reimbursed, in whole or in part, by any state or federal healthcare program, including, but not limited to, Medicare, Medicaid, Department of Defense (DoD), Veterans Affairs (VA), TRICARE, or any state or territory pharmaceutical assistance program. Patients who become eligible for or start using government insurance for their Takeda Oncology medications will no longer be eligible for the Program. The Program is not valid if the entire cost of your prescription is reimbursable by a private insurance plan or other private health or pharmacy benefit programs. You are responsible for reporting receipt of Program assistance to any insurer, health plan, or other third party who pays for or reimburses any part of the medication cost, as may be required.
You agree that you will not submit the cost of any portion of the product dispensed pursuant to this Program to a federal or state healthcare program (including, but not limited to, Medicare, Medicaid, TRICARE, VA, DoD, etc.), for purposes of counting it toward your out-of-pocket expenses, and to notify Takeda Oncology Here2Assist® if you become eligible for a federal or state healthcare program that covers your Takeda Oncology medication. This Program is not conditioned on any past, present or future purchase of any Takeda product, including refills. This Program is valid for up to 12 months, and your co-pay card may be renewed every 12 months, subject to continued eligibility at the beginning of each calendar year. This offer is not valid with any other program, discount, or offer involving your prescribed Takeda Oncology medication. This offer may be rescinded, revoked, or amended without notice. This offer is void where prohibited by law, taxed, or restricted. Limit one offer per purchase. No income requirements or membership fees. This Program is not health insurance. Cash value of 1/100 of 1¢. For questions about this offer, please contact the Takeda Oncology Co-Pay Assistance Program, a patient support service of Takeda Oncology Here2Assist, at 1-844-817-6468, Option 2, Monday-Friday, 8AM-8PM ET.