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Together with Tesaro Patient Assistance Program
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Phone
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844-283-7276
Fax:
800-645-9043
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Eligibility
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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
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Patients or healthcare providers can call the have an application faxed or download one. |
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Required
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Doctos must complete a section, sign, and attach required documents. Patients must also complete a section, sign, and attach required documents. |
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Supply
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1 Container |
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Ship To
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Doctor's office or patient's home |
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Note
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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. |
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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.
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| Varubi tablet |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form |
(Requires Acrobat Reader) 
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