Co-Pay Assistance Program
Contact us: (877) 557-2672 | firstname.lastname@example.org
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The Leukemia & Lymphoma Society (LLS) Co-Pay Assistance Program helps you pay your insurance premiums and meet co-pay obligations. We'll also help you find additional sources of financial aid. The Co-Pay Assistance Program offers financial help toward:
Blood cancer treatment-related co-payments
Private health insurance premiums
Medicare Part B, Medicare Plan D, Medicare Supplementary Health Insurance, Medicare Advantage premium, Medicaid Spend-down or co-pay obligations
You have complete freedom to choose doctors, providers, suppliers, insurance companies and treatment-related medications. You can make changes in any of the above at any time without affecting your continued eligibility.
Support for this program is based on the availability of funds by disease diagnosis. LLS Co-Pay Assistance funds are available for the following diagnoses:
- Chronic lymphocytic leukemia - assistance is available up to $2,500 (for applicants approved on or after 1/1/14)
- Chronic myeloid leukemia - assistance is available up to $500 (for applicants approved on or after 3/13/15)
- Lymphoma (Hodgkin and non-Hodgkin) - assistance is available up to $2,500 (for applicants approved on or after 1/1/14)
- Mantle cell lymphoma - assistance is available up to $5,000 (for applicants approved on or after 12/13/13)
- Myelodysplastic syndromes - assistance is available up to $5,000
- Myeloma - assistance is available up to $10,000
To be eligible for Co-Pay Assistance, you must
- Have a household income that is at or below 500 percent of the U.S. federal poverty guidelines as adjusted by the Cost of Living Index (COLI).
- Be a United States citizen or permanent resident of the U.S. or Puerto Rico and be medically and financially qualified
- Have prescription insurance coverage
- Have an LLS Co-Pay Assistance Program-covered blood cancer diagnosis confirmed by a doctor (see covered diagnoses listed above)
Online: Patients, caregivers, pharmacies and healthcare providers can easily submit online Co-Pay applications with a quick registration process, day or night. Your doctor, treatment provider or pharmacy can also apply for the program on your behalf.
- Patients and Caregivers: Submit an application now
- Pharmacies and Healthcare Providers: Submit a patient application now
Patients and providers may apply for assistance and check the status of submitted applications and claims 24 hours a day via the online portal.
By Phone: You may apply or get more information about the Co-Pay Assistance Program by calling (877) 557-2672 to speak with a Co-Pay Specialist who will provide personalized service throughout your application process.
For patients with approved applications who need assistance completing the Co-Pay Claim Form, please refer to the Claim Form Information Guide. The Co-Pay Claim Form is not available on the website for downloading. Please contact the Co-Pay Assistance Program at (877) 557-2672 to request a form.
In most cases, the payment will be sent directly to your pharmaceutical supplier, hospital, doctor and less commonly, directly to the patient. Claim requests for less than $20 will not be processed.
Click here for a list of covered and non-covered expenses.
Click here to access a list of frequently asked questions about the Co-Pay Assistance Program.
Access the Copayment Assistance Resource Guide for Blood Cancer Patients