Program Details
EMD SERONO
Oncology Navigation Center for Tepmetko
Tepmetko
(tepotinib)
|
CONTACT
INFO |
|
Address: |
, |
Phone: |
1-844-662-3631 |
Provider Phone: |
|
Fax: |
1-844-501-0062 |
Website: |
Program Website |
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ELIGIBILITY
|
|
Eligibility
Info: |
Program provides Tepmetko at no charge to patients who meet certain insurance (i.e., uninsured), income, and residency eligibility criteria.
To determine patient eligibility, providers should complete and fax the ONC Enrollment Form prior to treatment
Co-pay assistance, reimbursement support, patient support, and patient assistance programs are available for eligible patients. |
|
Couple |
|
% FPL |
Income at or below: |
Not
Published |
Medical expenses
can be deducted from reported income: |
Not
Published |
Social security requested on form: |
No |
US citizenship/residency specified:
|
Yes |
|
APPLICATION |
|
Attachments
Required: |
Financial
|
Physician
License #
Required: |
State
NPI
|
Prescriber
Signature
Allowed: |
Physician
|
Application
may be
faxed: |
Yes
|
Eligibility
determination
letter sent: |
Both Provider and Patient
|
|
MEDICATION |
|
Receives: |
Varies
|
Shipped To: |
Patient
|
Quantity in
Shipment: |
Not Published
|
Delivery Time: |
Not Published
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Re-application
Policy: |
Not Published |
Refill Policy: |
Not Published
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Other Information: |
|
|
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Last Updated: 01/30/2024
www.RxAssist.org
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