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#Copay card verification

Note: There is a separate portal for all other Patient Financial Assistance Programs LLS offers patients, caregivers, pharmacies, and healthcare providers two easy ways to register/apply:

#Copay card verification

In the event that you are unable to get your doctor to sign off on the Diagnosis Verification Form for your application, we will accept a portion of your electronic medical record (EMR) or other documentation that shows the diagnosis/ICD-10 code. *Healthcare Professionals (HCP) applying on behalf of a patient will be asked for their NPI and tax ID. This information will not be shared and is for verification purposes only.

The name of treating physician and their phone/fax numbers.

The name of your pharmacy and its phone/fax numbers.

Insurance card, as well as Medicare/Medicaid.

If the patient is a minor, you will need a guardian Social Security number as well.

The patient's demographic information (including their Social Security number and date of birth) and their contact information.

STEP 1: Gather the following information. If you prefer to apply on your own, please refer to the information below. You may call (877) 557-2672 to speak with an Intake Specialist who can walk you through the application process. Please visit our website in the future to become aware of new funding. Program continuation is dependent on the availability of funds and the program could be modified or discontinued at any time if funding is limited or no longer available. Renewal patients are those who have received assistance through our program in the past and continue to reapply.Īs a non-profit organization, we rely on the generosity of our sponsors. *Philadelphia Chromosome Negative Myeloproliferative Neoplasms only.Ī fund that is “fully subscribed” is at maximum capacity, serving those enrolled, and is not enrolling additional patients (new or renewal patients).

Plasma cell leukemia or plasma cell myeloma.

Juvenile myelomonocytic leukemia (JMML) (diagnosis formerly known as chronic myelomonocytic leukemia of infancy ).

Please refer to our booklet, Non-Hodgkin Lymphoma, for additional subtypes ( click here).

Post-transplant lymphoproliferative disorder or PTLD.

T-cell large granular lymphocytic leukemia (LGL).

The Trish Greene Back to School Programįully subscribed and closed to enrollment.