2013 Patient Assistance and Reimbursement Guide - Association of ...

PAP Quick Reference Guide
Drug Name Brand Name Drug Company
Benefit
Verification
and
Authorization
Support
Drug
Company
Co-Pay
Assistance
Foundation
Assistance
14
Clofarabine Clolar Genzyme X
CPT-11 Camptosar Pfizer X D, H, P
Crizotinib Xalkori Pfizer X
Cyclophosphamide Cytoxan H
Cyclophosphamide Neosar H
Cytarabine Cytosar-U H
Dactinomycin Cosmegen Lundbeck D, H
Dacarbazine DTIC H
Darbepoetin Aranesp Amgen X H, P, F
Dasatinib Sprycel Bristol-Myers Squibb X
Daunorubicin
Cerubidine
Decitabine Dacogen Eisai X
Deferasirox Exjade Novartis X
Degarelix Firmagon Ferring X
Denileukin diftitox Ontak Eisai X
Denosumab Prolia Amgen X X H, P, F
Denosumab Xgeva Amgen X X H, P, F
Dexrazoxane Totect TopoTarget X X
Dexrazoxane Zinecard Pfizer X X X
Docetaxel Taxotere Sanofi X D, H, P
Doxorubicin Adriamycin H
Doxorubicin Liposome Doxil Janssen Products X D, H, P
Eltrombopag Promacta GlaxoSmithKline X X H, A, F, P
Enzalutamide Xtandi Astellas Oncology X X
Epirubicin Ellence Pfizer X D, H
Epoetin Alpha Procrit Janssen Products X D, H
Erlotinib Tarceva Genentech X X H, P
Erwinia Asparaginase Elspar D, H
Estramustine Emcyt Pfizer X X P
Etoposide Etopophos Bristol-Myers Squibb H
Etoposide VePesid H
Etoposide Toposar H
Everolimus Afinitor Novartis X D, P
Exemestane Aromasin Pfizer X X H, P, U
Filgrastim Neupogen Amgen X D, H, P
Finasteride Proscar Merck M
Flourouracil 5FU D, H
Floxuridine FUDR H
Fludarabine Fludara H, P
Fluoxymesterone Halotestin H
Flutamide Eulexin H, P
Fulvestrant Faslodex AstraZeneca D, H, P
Gefitinib Iressa AstraZeneca H, P
Gemcitibine Gemzar Eli Lilly D, H, P
Gemtuzumab Ozogamicin Mylotarg Pfizer X X H, P, U
Goserlin Zoladex AstraZeneca D, H, P
Granisetron Sancuso ProStrakan X X X
Hydroxyurea Droxia Bristol-Myers Squibb A
ACCC 2013 Patient Assistance and Reimbursement Guide