American Society of Hematology

Access Programs for Chlorambucil


Updated on: February 17, 2016

Drug Company Assistance

The GlaxoSmithKline Commitment to Access Program provides pharmaceutical products at little to no cost for qualified patients.  Chlorambucil can be obtained through this program if the patient resides in the US, is not eligible for Medicaid, is enrolled in Medicare Part D, and meets certain income requirements.  The patient must also have spent at least $600 on prescription drugs within the last calendar year.  For more information on eligibility, please visit the Commitment to Access eligibility page, or call 1-866-265-6491.

Enrollment in the program requires two steps.  First, someone involved in delivering the patient’s healthcare, such as a healthcare provider or social worker, must register as a patient advocate.  The enrollment form must be completed along with original documents mailed or faxed. There is a checklist included with the enrollment form. 

Finally, advocates should ensure that all supporting documentation, such as copies of Medicare Part D Prescription Plan ID Cards, proofs of yearly prescription spending, and proofs of household income, are attached to the application.  The forms can be submitted via fax at 1-866-936-3422.

Foundation Assistance

The Health Well Foundation provides grants for patients with insurance who still have trouble affording chlorambucil.  Patients or providers can apply online or call 1-800-675-8416 to speak with a representative.

The Patient Access Network Foundation also offers copay assistance for patients needing chlorambucil.  Please read the application instructions, and then follow the prompts on the online application.

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