Patient Enrollment/How to Enroll

3 Steps to Patient Enrollment

You or your Advocate can complete and print the COMMITMENT TO ACCESS^® application online. To view the enrollment application, you will need Adobe^® Acrobat^® Reader. If you do not have it, click here to download a copy. For help completing the application, call Commitment to Access^® at 1-8ONCOLOGY1 (1-866-265-6491).
Be sure to sign and date the "Patient Authorization to Release and Disclose Medical Information" section.
Your Advocate can also request an application by calling Commitment to Access at 1-8ONCOLOGY1 (1-866-265-6491).
Each application has a unique 9-digit identification number that serves as your Commitment to Access ID number for as long as you remain in the program. Because the application has a unique ID number, it may not be photocopied.

Call 1-866-265-6491

Select someone involved in your healthcare to enroll you into Commitment to Access by telephone. This person may be a health care worker, social worker, case worker, or anyone involved in the delivery of your healthcare. This person is your Advocate.
Review the completed application and documents with your Advocate.
Your Advocate will call 1-8ONCOLOGY1 (1-866-265-6491) to find out if you are eligible to receive medicine.
If eligible, your first fill of medication will automatically be sent to the address provided on your application.

For details on how to re-enroll in Commitment to Access, click here.

To find out how to receive medication and refills, click here.