| |
Abraxis Patient Access Program (APAP)
|
6900 College Blvd
Suite 1000
Overland Park, KS 66211
Phone
:
800-564-0216
Ext OPT 3
Fax:
866-242-4141
|
|
Eligibility
|
| > |
The patient must be uninsured or underinsured and have a gross annual household income at or below $100,000. The patient must have any diagnosis deemed medically necessary by the oncologist. |
| Who Can Apply
|
| > |
Patients or providers |
|
Required
|
| > |
Original MD Signature on the application |
|
Supply
|
| > |
Shipments are sent per cycle. Prospectively for uninsured patients and replaced for insured patients if their insurance denies the claim and the appeal is unsuccessful. One level of appeal must be conducted with the assistance of ARC of Support” 600.564.0216, option 3. |
|
Ship To
|
| > |
Doctor |
|
Note
|
| > |
Complete Appeals Assistance is available to patients with private insurance or traditional Medicare with a signed ABN. Patient assistance applications can be submitted online at www.AbraxisReimbursement.com, in the ARC section of Abraxane.com or AbraxisOncology.com. There are also editable versions of the APAP application, Benefit Investigation Request Form and sample Letter of Medical Necessity (LMN). Fax all forms to ARC of Support at 866.242.4141 if submitting hard copies. |
| |
| |
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
|
| Download printable Form APAP Enrollment Application |
| Download printable Form APAP Benefit Investigation Request Form |
(Requires Acrobat Reader) 
|
| |
|
|