|
 |
Getting Started |
|
|
|
|
|
|
Qualify and Enroll
|
- Visit Advocate with
completed form and current income documentation.
- If eligible, product will be shipped to your prescriber.
|
|
- Complete Enrollment, Patient Health and Allergy Information, and Patient Authorization to
Release and Disclose Medical Information forms with patient.
- Ensure all forms are signed by the patient, the prescriber and the advocate where appropriate.
- Call 1-8-ONCOLOGY1 (1-866-265-6491) to enroll patient. You will be informed what documentation is required.
- After eligibility is granted fax a 30-day prescription (for up to 13 refills) to 866-750-9832.
- Within 20 days, mail patient's required
documentation to Commitment to Access.
|
|
Order Refills
|
- Contact your advocate to order refills.
|
|
- Advocates can order refills by calling 1-8-ONCOLOGY1 7 to 10 business days before the next scheduled treatment date, or before the supply of drug runs out.
- Before requesting a refill please verify that the patient is still eligible for the program, they have an active drug authorization for the medication(s) requested and a valid mail order prescription(s) on file with Walgreens.
|
|
Re-Enroll
|
- Re-enroll in
program after one year, if necessary.
|
|
- Help patient(s) re-enroll
if assistance is still needed.
- A letter and patient-specific re-enrollment form will be sent
to the Advocate before it is time for the patient to re-enroll.
|
