Taiho Oncology Patient Support

Patient Support Services Guide 2018

Taiho Oncology Patient Support

The Taiho Oncology Patient Support program was established in September 2015 by Taiho Oncology and provides a range of personalized support services for patients who have been prescribed Lonsurf (trifluridine and tipiracil), including access and reimbursement support, specialty pharmacy prescription coordination, and copay support, based on their financial needs and insurance coverage.

Lonsurf is indicated for the treatment of patients with metastatic co­lorectal cancer who have previously received other chemotherapy treatment for this type of cancer (Table).

Financial Assistance Programs

The financial assistance options for Lonsurf include:

The Taiho Oncology Patient Support Co-pay Card is for eligible patients with commercial insurance. Eligibility criteria apply, and more information can be found by contacting Taiho Oncology Patient Support. This card assists with out-of-pocket expenses for Lonsurf, and limits the copay for patients to $30 per treatment cycle.

The Taiho Oncology Patient Assistance Program provides medication at no charge for patients with no or with insufficient prescription insurance coverage, or based on financial and other eligibility criteria.

For government-insured patients, such as those with Medicare or Medicaid, or those who need financial assistance, Taiho Oncology Patient Support may be able to provide referrals to nonprofit organizations that may be able to assist with copays.


To be eligible for the Taiho Oncology Patient Support Co-pay Card, the following requirements must be met:

  • Patients must reside in the United States, Puerto Rico, or the US territories
  • Patients must be prescribed Lonsurf
  • Patients must have commercial prescription insurance coverage for Lonsurf
  • The prescription must not be eligible to be reimbursed by government-subsidized healthcare programs, including Medicare, Medicaid, TRICARE, or any other federal or state programs, such as medical assistance programs.

Eligible patients may use a specialty pharmacy, hospital outpatient pharmacy, or receive medicine from a doctor’s office.

Application & Enrollment

Enrollment in the Taiho Oncology Patient Support program requires the completion of all applicable sections of the Patient Enrollment Form, including the Patient Authorization section, and faxing it to the number provided on the form. For more information about this program, visit TaihoPatientSupport.com or call 844-824-4648.

The prescriber is required to provide the patient’s complete diagnosis and clinical information, including diagnosis code, clinical stage, line of therapy, specific previous treatment received, completion of an EGFR test, and KRAS mutation status. Patient information, including health insurance information, must be provided, and a copy of the patient’s insurance card must be submitted along with the application.

If the patient has no insurance and a referral to the Taiho Oncology Patient Assistance Program is required, the Patient Assistance Program section of the Patient Enrollment Form (on page 3 of the form) must also be completed.

Information regarding annual household income, including Supplemental Security Income, pension income, as well as the number of people living in the household, must be included.

Proof of income must be provided, such as household federal tax returns or pay stubs, bank statements of deposit, or a Social Security or disability statement (if not filing taxes).

After enrollment in the Taiho Oncology Patient Support program, a reimbursement specialist will either confirm the patient’s access to Lonsurf through insurance coverage or will assist in applying for financial assistance.

Other Services

The Taiho Oncology Patient Support program provides additional access services, including:

  • Access and reimbursement support, which may include conducting benefit verifications to determine insurance coverage for Lonsurf and out-of-pocket responsibilities for patients, as well as assist with prior authorizations and claims appeals if coverage is denied
  • Specialty pharmacy prescription coordination, which can assist with prescription triage and coordination with in-network specialty pharmacy, self-dispensing practice, or hospital retail pharmacy
  • Adherence support, which includes refill reminders
  • Live telephone support, including on-call nurse telephone support.

To find information about Lonsurf distribution, contact Taiho Oncology Patient Support.

The Taiho Oncology Patient Support Co-pay Card may be presented to the self-dispensing practices and hospital retail pharmacies, or when the specialty pharmacy contacts the patient regarding payment and shipment. The patient receives Lonsurf from the patient’s specialty pharmacy, the physician, or the hospital.

Table Taiho Oncology Drug

Patient support programs

Lonsurf (trifluridine and tipiracil)
Metastatic colorectal cancer, after treatment with chemotherapy, an anti-VEGF biologic therapy, or, if RAS wild-type, an anti-EGFR therapy