Program Details
KITE PHARMA, INC.
KiteConnect
Tecartus
(brexucabtagene autoleucel)
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| CONTACT
INFO |
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| Address: |
, |
| Phone: |
1-844-454-5483 |
Provider Phone: |
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| Fax: |
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Website: |
Program Website |
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| ELIGIBILITY
|
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| Eligibility
Info: |
Contact program for details.
Program helps with benefits investigations, claims appeals information, and potential sources of support for eligible uninsured and underinsured patients. For eligible patients resources may include referrals to independent third-party nonprofit patient assistance programs. |
| |
Couple |
|
% FPL |
| Income at or below: |
Not
Published |
| Medical expenses
can be deducted from reported income: |
Not
Published |
| Social security requested on form: |
Not
Published |
| US citizenship/residency specified:
|
Not
Published |
|
|
APPLICATION |
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| Attachments
Required: |
Not Published
|
Physician
License #
Required: |
Not Published
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Prescriber
Signature
Allowed: |
Not Published
|
Application
may be
faxed: |
Not Published
|
Eligibility
determination
letter sent: |
Not Published
|
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| MEDICATION |
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| Receives: |
Not Published
|
| Shipped To: |
Not Published
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| 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: 05/15/2024
www.RxAssist.org
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