Adcetris Patient Assistance Programs

Adcetris: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Adcetris. Review the information to see if you qualify. The applications are available in Adobe PDF format and should be mailed directly to the provider of the patient assistance program.

If you have any questions, please call the telephone number for the program (not PharmacyChecker.com) or go to the program website.

Looking for a different medication?

Good Days Program

(Program 1 of 3 — Scroll down to see them all )

Provided by: Good Days from CDF
Attn: Enrollment 6900 Dallas Parkway Suite #200 Plano, TX 75024
TEL: 877-968-7233
FAX: 214-570-3621
Languages Spoken:
English
Program Website
Medications
  • Adcetris (brentuximab vedotin)
Eligibility Requirements
  • Insurance Status Not specified
  • Those with Part D Elibible? Not specified
  • Income Not disclosed
  • Diagnosis/Medical Criteria Not specified
  • U.S. Residency Required? US residency requirements are not specified.
Application
  • Obtaining Call, download or apply online
  • Receiving Faxed, mailed or downloaded from website
  • Returning The completed application can be faxed, mailed or submitted online.
  • Doctor's Action Give prescription to patient
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Patient and/or Doctor are notified
  • Decision Timeframe Varies
Medication
  • Amount/Supply Not specified
  • Sent To Not specified
  • Delivery Time Not specified
  • Refill Proces Not specified
  • Limit Not specified
  • Re-application Must re-enroll at end of calendar year
Additional Information
Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly.
Updated October 5, 2018

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SeaGen Secure Patient Assistance Program

(Program 2 of 3 — Scroll down to see them all )

Provided by: Seattle Genetics, Inc.
21823 30th Dr. SE Bothell, WA 98021
TEL: 855-473-2873
FAX: 855-557-2480
Languages Spoken:
English, Others By Translation Service
Program Website
Medications
  • Adcetris (brentuximab vedotin)
Eligibility Requirements
  • Insurance Status Uninsured or Underinsured
  • Those with Part D Elibible? Not applicable
  • Income Gross family household income at or less than $135,000
  • Diagnosis/Medical Criteria HL or NHL
  • U.S. Residency Required? Must permanently reside in the US and be under the direct care of a US Physician
Application
  • Obtaining Call, download or apply online
  • Receiving Faxed, emailed or downloaded from website
  • Returning Email or fax
  • Doctor's Action Complete section
  • Applicant's Action Complete section and attach required documents
  • Decision Communicated Patient and Doctor are notified
  • Decision Timeframe Within 24-48 hours
Medication
  • Amount/Supply Varies. *see below for details
  • Sent To Clinic or hospital
  • Delivery Time Shipped overnight
  • Refill Proces Doctor/Doctor's office must complete a Product Request Form per cycle
  • Limit None
  • Re-application New enrollment every 12 months
Additional Information
* If approved, one cycle will be shipped to the Provider for IV administration. Patient can be on any line of therapy, any dosing schedule, and be pre or post Autologous Stem Cell Transplant. Co-ppayment assistance, insurance benefit investigation, claims assistance and/or other reimbursement help is offered. Income and residency documentation required.
Updated August 16, 2018

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Patient Access Network Foundation (PAN)

(Program 3 of 3 — Scroll down to see them all )

Provided by: Patient Access Network Foundation
None
TEL: 866-316-7263
FAX: 866-316-7261
Languages Spoken:
English, Spanish, Others By Translation Service
Program Website
Medications
  • Adcetris (brentuximab vedotin)
Eligibility Requirements
  • Insurance Status *See Additional Information section below
  • Those with Part D Elibible? Determined case by case
  • Income Between 400-500% of FPL
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? Must reside and receive treatment in US
Application
  • Obtaining Call or complete online
  • Receiving Complete online or by phone
  • Returning Complete online or by phone
  • Doctor's Action Will be discussed with patient and Doctor after request is received
  • Applicant's Action Call for information or inform doctor that he/she is in need
  • Decision Communicated Patient and Doctor notified in writing
  • Decision Timeframe Within 48 hours
Medication
  • Amount/Supply Not applicable
  • Sent To Patient sent card to be used at pharmacy
  • Delivery Time Once approved; shipped same day
  • Refill Proces Patient presents voucher/card to pharmacy for each refill
  • Limit None
  • Re-application New application every 12 months
Additional Information
*Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance. Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly. Note: All new enrollment is now done electronically or over the phone. Contact program for details.
Updated July 10, 2018

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