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
18
Pegaspargase Oncaspar Sigma-Tau X X
Pegfilgrastim Neulasta Amgen X X D, H
Pemetrexed Alimta Eli Lilly D, H, P
Pentostatin
Nipent
Plerixafor Mozobil Sanofi X X D, P
Plicamycin
Mithracin
Ponatinib Iclusig Ariad Pharmaceuticals X X D
Pralatrexate Folotyn Spectrum X O
Pharmaceuticals
Procarbazine Matulane Sigma-Tau X X H
Radium Ra 223 dichloride Xofigo Bayer Healthcare X X X
Rasburicase Elitek Sanofi X H, P, F, O
Regorafenib Stivarga Bayer Healthcare X X X
Rituximab Rituxan Genentech X X D, H, P
Romidepsin Istodax Celgene X P
Romiplostim Nplate Amgen X X H, P, F
Ruxolitinib Jakafi Tab Incyte X X X
Sargramostim Leukine Sanofi X X H
Sipuleucel-t Provenge Dendreon X P
Sorafenib Nexavar Bayer Healthcare X X D, P
Streptozocin
Zanosar
Sunitinib Sutent Pfizer X D, P
Tamoxifen Nolvadex H, M
Temozolomide Temodar Merck X D
Temsirolimus Toresel Pfizer X P
Teniposide Vumon Bristol-Myers Squibb H
Thalidomide Thalomid Celgene X D, H, P
Thiotepa Thioplex H
Topotecan Oral Hycamptin Oral GlaxoSmithKline X X D, H, P
Topotecan Hycamptin GlaxoSmithKline X X D, H, P
Toremifene Fareston ProStrakan X X X
Tositumomab Bexxar GlaxoSmithKline X H
Trastuzumab Herceptin Genentech X X D, H, P
Tretinoin (ATRA) Vesanoid Roche X
Triptorelin Pamoate Trelstar Watson X
Valrubicin
Valstar
Vemurafenib Zelboraf Genentech X X X
Vinblastine Velban H
Vincristine Oncovin D, H
Vincristine sulfate liposome Marqibo Talon
Vinorelbine Navelbine PF Pharmaceuticals H
Vorinostat Zolinza Merck X D, P
VP-16 Etopophos Bristol-Myers Squibb H
VP-16 VePesid H
Zidovudine Retrovir X
Ziv-Aflibercept Zaltrap Sanofi X X
Zoledronic acid Zometa Novartis X D, P
ACCC 2013 Patient Assistance and Reimbursement Guide