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
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
    Re-application Policy: Not Published
    Refill Policy: Not Published
    Other Information:

    Last Updated: 01/30/2024


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