ARIAD

Featured Drug Company Program


ARIAD PASS: Patient Access & Support Services

855-447-7277 (855-447-PASS)
www.ariadpass.com

ARIAD’s Patient Access & Support Services program (ARIAD PASS) is a comprehensive support program that provides coverage and reimbursement support, as well as financial assistance for patients who have been prescribed Iclusig (ponatinib) and are unable to afford their medication.

Iclusig (Table) is indicated for the treatment of adults with T315I-positive chronic myeloid leukemia (CML) or with T315I-positive Philadelphia chromosome–positive (Ph+) acute lymphoblastic leukemia (ALL).

Table ARIAD Oncology Drugs
Drug Indications Patient support programs Contact information
Iclusig
(ponatinib)
Chronic myeloid leukemia with T315I mutation; Ph+ acute lymphoblastic leukemia with T315I mutation ARIAD Copay PASS www.ariadpass.com/hcp.html
ARIAD Patient Assistance
Program
ARIAD QuickStart PASS
Ph+ indicates Philadelphia chromosome–positive.

ARIAD PASS offers eligible patients a range of financial assistance options, including copay or coinsurance support, based on their financial needs and insurance coverage, whether they have private or commercial insurance, have government-sponsored insurance, or are uninsured.

ARIAD PASS offers several financial assistance options.

ARIAD Copay PASS

This program is available for patients with private insurance. This program assists eligible patients with copay and coinsurance based on their insurance coverage.

The program limits the patient’s copay to $10 monthly for eligible patients, up to a maximum benefit of $8000 per 30-day prescription and up to a maximum total of $24,000 per calendar year.

ARIAD Patient Assistance Program

This program provides free medication for up to 1 year for eligible patients without insurance.

For patients with government-­sponsored insurance, such as Medicare or Medicaid, or those with no insurance who need financial assistance, ARIAD PASS may be able to provide a referral to a charitable organization or to the ARIAD Patient Assistance Program.

ARIAD QuickStart PASS

This program provides access to Iclusig if there is a reimbursement delay. A one-time, 30-day supply is given to patients to ensure that they can start their medication free of cost.

Eligibility

To be eligible for the ARIAD Copay PASS program, the following requirements must be met:

  • Patients must reside in the United States or Puerto Rico
  • Patients must be prescribed Iclusig
  • The prescription must not be eligible to be reimbursed by commercial insurance plans or other health or pharmacy benefit programs; government-subsidized healthcare programs, including Medicare, Medicaid, TRICARE; or any other federal or state healthcare plan.

Application & Enrollment

Enrollment to the ARIAD PASS program requires completing the ARIAD PASS Prescription Form (available at www.ariadpass.com/packaged/assets/pdf/ARIAD_PASS_Prescription_Form.pdf), and faxing it to the number provided on the form (800-823-4506).

The prescriber is required to indicate the patient’s diagnosis (including the ICD-10 code), the phase of CML, the reason for initiating Iclusig (ie, T315I mutation, or if no other tyrosine kinase inhibitor is indicated), whether mutational testing has been conducted, any previous CML/Ph+ ALL therapies, and the clinical service setting.

The patient’s information, including health insurance information and residency, must also be provided.

Receiving Iclusig

Iclusig prescriptions are filled via ARIAD’s specialty pharmacy, Biologics. The Biologics oncology pharmacy team will assist patients with clinical questions about drug interactions, dosages, and side effects.

Once a benefits investigation is complete, a Biologics oncology pharmacist will contact the patient to schedule delivery of Iclusig and to perform an initial baseline assessment. The team can also help set up free delivery of the patient’s medicine and free refill delivery based on the patient’s therapy schedule.