

**As a non-profit organization, we rely on the generosity of our sponsors. Program continuation is dependent on the availability of funds and the program could be modified or discontinued at any time if funding is limited or no longer available. Please visit our website in the future to become aware of new funding.**





Program Eligibility Criteria

To be eligible for Co-Pay Assistance, you must

Be a United States citizen or permanent resident of the U.S. or U.S. territory.

Have a household income that is at or below 500 percent of the U.S. federal poverty guidelines as adjusted by the Cost of Living Index (COLI). You will be asked for your zip code to determine your COLI.

Have medical insurance and/or prescription insurance

Have a blood cancer diagnosis confirmed by a doctor Patient must be in active treatment, scheduled to begin treatment, or is being monitored by their doctor.







How to Apply

STEP 1: Gather the following information

The patient's demographic information (including their Social Security number and date of birth) and their contact information. If the patient is a minor, you will need a guardian Social Security number as well.

The name of your diagnosis.

Estimated household financial income.

Insurance card, as well as Medicare/Medicaid.

The name of your pharmacy and its phone/fax numbers.

The name of treating physician and their phone/fax numbers.

This information will not be shared and is for verification purposes only.

*Healthcare Professionals (HCP) applying on behalf of a patient will be asked for their NPI and tax ID.

**UPDATE DUE TO COVID-19**

For new applicants, in the event that you are unable to get your doctor to sign off on the Diagnosis Verification Form ​​​​​​for your application, we will accept a portion of your electronic medical record (EMR) or other documentation that shows the diagnosis/ICD-10 code.

Please note, this is a temporary workaround given the national health emergency.





STEP 2: Register and/or Apply

LLS offers patients, caregivers, pharmacies, and healthcare providers two easy ways to register/apply:

By Phone: (877) 557-2672

Monday to Friday, 8:30 a.m. to 5:00 p.m.

OR

Online: Online portal

24/7, Available in English only

If you do not have an LLS Financial Assistance Copay Portal Account:

If this is your first time visiting the LLS Financial Assistance Copay Portal, you will need to register before you can start the online application. To create a portal account :

Complete the registration form in the LLS Financial Assistance Copay Portal and submit.

Receive confirmation email (typically within 5 minutes of submitting) and click on the link provided to create a password.

Create password

Log on to the LLS Financial Assistance Copay Portal using newly created password.

Begin application process. All required fields must be completed.

Upon completing your application, submit for review.

If you already have an LLS Financial Assistance Copay Portal Account:

If you are returning to the LLS Financial Assistance Copay Portal, please log in, select Co-Pay Assistance Program, and fill out required fields.

Need Help?

For portal technical support, please call us at (877) 557-2672 or e-mail financialassistance@lls.org.





Claims Information

Approved patients must submit a claim for a covered expense every 90 days to keep their accounts active.

Please contact the Co-Pay Assistance Program at (877) 557-2672 for instructions on how to submit a claim.





Frequently Asked Questions





Contact Information

The Leukemia & Lymphoma Society

Co-Pay Assistance Program

P.O. Box 12268

Newport News, VA 23612

Email: FinancialAssistance@LLS.org

Toll Free Phone: (877) 557-2672

Fax: (877) 267-2932



We Want to Hear How This Program Has Helped You!

We would love to hear how the financial assistance provided by LLS has helped you. Patient stories help us illustrate the impact and importance of this program in the lives of blood cancer patients.

Submit a Story

To submit a story by mail, please send to:

The Leukemia & Lymphoma Society

Patient Financial Assistance Programs

3 International Drive, Suite 200, Rye Brook, NY 10573

Thank you for sharing!

Office of Inspector General (OIG) Advisory Opinion

Other Helpful Resources



