FRUZAQLA

Indicated For

metastatic colorectal cancer, 3rd line

About This Medication

# Takeda Oncology Patient Assistance Program: How to Get FRUZAQLA at Low or No Cost ## About FRUZAQLA FRUZAQLA (fruquintinib) is an oncology medication prescribed by your healthcare provider to treat certain types of cancer. If you're struggling to afford this medication, the Takeda Oncology Patient Assistance Program, also known as Here2Assist®, may help you access FRUZAQLA at no cost. ## Who Qualifies for This Program? You may be eligible for the Takeda Oncology Patient Assistance Program if you meet these criteria: - You are a resident of the United States or a U.S. territory - You are at least 18 years old - You have been prescribed FRUZAQLA by a U.S. licensed physician - You are either uninsured OR your insurance does not cover FRUZAQLA - You meet the program's financial and insurance coverage criteria The program is designed to help patients with limited or no prescription insurance access their medications without financial hardship. ## Income Eligibility While specific income thresholds are not publicly listed, the program uses a needs-based assessment. You will need to provide proof of your current income when you apply. The program reviews each application individually to determine financial eligibility based on your household situation. ## Insurance Requirements You are eligible if: - You have no health insurance coverage for prescriptions, OR - Your insurance does not cover FRUZAQLA, OR - You are underinsured and cannot afford your medication If you have Medicare, Medicaid, or other insurance, you may still qualify if your plan doesn't cover FRUZAQLA or if you cannot afford your out-of-pocket costs. ## How to Apply: Step-by-Step **Step 1: Download the Enrollment Form** Visit www.Here2Assist.com and download the Takeda Oncology Here2Assist Enrollment Form. You can also ask your healthcare provider's office to help you obtain this form. **Step 2: Complete the Form with Your Healthcare Provider** Work with your doctor or their office staff to complete the entire enrollment form. You will need to provide: - Your complete personal information - Your prescriber's information - Your current insurance information (if applicable) - Proof of your household income - A statement of medical necessity from your prescriber - Your original signature and your prescriber's original signature **Important:** Original signatures are required. Stamped or digital signatures will not be accepted, and applications without original signatures cannot be processed. **Step 3: Gather Required Documents** Before submitting, ensure you have: - The completed and signed enrollment form - A valid prescription for FRUZAQLA from your healthcare provider - A copy of your insurance card (if you have insurance) - Proof of income (such as recent pay stubs, tax returns, or benefit statements) **Step 4: Submit Your Application** Fax your completed enrollment form, prescription, and supporting documents to: **1-844-269-3038** Alternatively, you can call the Here2Assist team at **1-844-817-6468, Option 2** to discuss your application or ask questions. They are available Monday-Friday, 8 AM-8 PM ET. ## Timeline and Medication Delivery Once you submit your application: 1. **Enrollment Verification:** A Takeda Oncology Here2Assist case manager will review your application and contact you and your healthcare provider to confirm enrollment status. 2. **Approval and Delivery:** If approved, your first one-month supply of FRUZAQLA will be shipped directly to you at no cost. 3. **Ongoing Support:** Each month, a case manager will contact you to confirm you are still being treated and remain eligible to receive another month's supply. 4. **Duration:** If you qualify, you may receive assistance for up to one year. Your case manager will help you with reauthorization if needed. ## What Happens If Your Application Is Denied? If you do not qualify for the patient assistance program, ask your case manager about: - Other financial assistance programs that may be available - Co-pay assistance programs through Takeda Oncology - State pharmaceutical assistance programs - Specialty pharmacy resources that may offer additional support - Payment plans or discounts your healthcare provider may know about Your case manager is available to discuss alternative options and help you find resources. ## Important Reminders - **Original Signatures Required:** Your application cannot be processed without original signatures from both you and your prescriber. - **Complete Information:** Incomplete applications will be delayed. Use the checklist on the enrollment form to ensure all sections are filled out. - **Regular Contact:** Once enrolled, expect monthly check-ins from your case manager to confirm your continued eligibility. - **Insurance Changes:** Notify your case manager immediately if your insurance coverage changes. ## Get Help For questions about the Takeda Oncology Patient Assistance Program or to start your application: **Call:** 1-844-817-6468, Option 2 **Hours:** Monday-Friday, 8 AM-8 PM ET **Website:** www.Here2Assist.com The Here2Assist team is committed to helping you access the medication you need. Don't hesitate to reach out with questions at any stage of the process.

Program information last verified: March 30, 2026