Iclusig Prescription Assistance Programs

Iclusig: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Iclusig. 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?

Takeda Oncology 1Point

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

Provided by: Takeda Pharmaceutical
PO Box 4280 Gaithersburg, MD 20885-4280
TEL: 844-817-6468
FAX: 844-269-3038
Languages Spoken:
English, Others By Translation Service
Program Website
Medications
  • Iclusig tablet (ponatinib tablet)
Eligibility Requirements
  • Insurance Status Contact program for details.
  • Those with Part D Elibible? No
  • Income Not disclosed
  • Diagnosis/Medical Criteria Medically appropriate condition/diagnosis
  • U.S. Residency Required? The patient must also be a US resident.
Application
  • Obtaining Call or download
  • Receiving Faxed, emailed or downloaded from website
  • Returning *See Additional Information section below
  • Doctor's Action Complete section, sign, attach required documents
  • Applicant's Action Complete section, sign, attach required documents
  • Decision Communicated Doctor notified
  • Decision Timeframe 2 business days, once application process is complete
Medication
  • Amount/Supply Up to 1 month supply
  • Sent To Patient's home, unless otherwise noted
  • Delivery Time Not specified
  • Refill Proces Company contacts patient or doctor to arrange
  • Limit One year
  • Re-application Maximum is one year
Additional Information
Co-payment assistance and assistance programs are available for eligible patients.
Updated August 5, 2019

If you, your patient or loved one does not qualify for this program or other prescription savings programs, then please search for prices here.

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