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Patient Assistance Information

 
Program Sponsored By Tesaro Biopharmaceutical (External Link)
 
 
Together with Tesaro Patient Assistance Program


,
Phone : 844-283-7276
Fax: 800-645-9043
Eligibility
> Insurance status will be considered on a case by case basis. Patients must meet income requirements that have not been disclosed and have a medically appropriate condition/diagnosis.
Who Can Apply
> Patients or healthcare providers can call the have an application faxed or download one.
Required
> Doctos must complete a section, sign, and attach required documents. Patients must also complete a section, sign, and attach required documents.
Supply
> 1 Container
Ship To
> Doctor's office or patient's home
Note
> This program also provides copay assistance and they will provide a Free First Dose of VARUBI (rolapitant), if there is a delay in coverage determination. Contact the program for more detail.
 
Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
 
Varubi tablet
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader