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.
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
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