Iclusig

Indicated For

Chronic myeloid leukemia (CML), Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL)

About This Medication

# Takeda Oncology Patient Assistance Program Patient Guide: How to Get **Iclusig (ponatinib)** at Low or No Cost This guide explains how to access **Iclusig (ponatinib)** through the **Takeda Oncology Patient Assistance Program** (PAP). Iclusig is a prescription medication used to treat certain types of leukemia, and this program helps eligible patients get it for free if they lack insurance coverage or the drug isn't covered. ## About Iclusig (ponatinib) **Iclusig (ponatinib)** is a targeted therapy approved for adults with chronic myeloid leukemia (CML) or Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) who have specific genetic mutations or have not responded to prior treatments. It works by blocking enzymes that cancer cells need to grow. Always take it as prescribed by your doctor, and discuss side effects like high blood pressure, heart issues, or bleeding risks. ## Who Qualifies for the Program? The **Takeda Oncology Patient Assistance Program**, managed through **Here2Assist**, provides **Iclusig** at no cost to patients who meet these key criteria: - **Age**: At least 18 years old. - **Residency**: U.S. resident or U.S. territory resident. - **Insurance Status**: Uninsured, or insured but the medication is not covered by your plan. You cannot qualify if you have coverage through: - State or territory pharmaceutical assistance programs. - Medicare Part D, Medicare Advantage Plans, Medicaid Managed Care, ACA Alternative Benefit Plans, Medigap, or insurance paying the full prescription cost. - **Prescription**: Must be prescribed by a U.S.-licensed physician. **Income Eligibility**: Specific income thresholds (e.g., Federal Poverty Level percentages) are not publicly detailed but evaluated case-by-case via the application. Provide accurate financial information, including proof of income, for review. The program prioritizes those with financial need and no/insufficient coverage. | Household Size | Income Threshold | Notes | |---------------|------------------|-------| | Individual | Case-by-case | Based on financial info submitted; no fixed FPL % listed | | Couple | Case-by-case | Income verification required | | Family of 3 | Case-by-case | Program confirms eligibility after review | | Family of 4+ | Case-by-case | U.S. residency and insurance status primary qualifiers | ## Insurance Requirements This program is for **uninsured patients** or those whose insurance **does not cover Iclusig**. Attach copies of both sides of your insurance card(s) (medical and pharmacy) to verify. If you're on Medicare, Medicaid, or similar government programs that cover the drug fully, you won't qualify. Patients in the Medicare coverage gap may still be ineligible if other criteria apply. The program reviews insurance details to confirm the drug is not covered. ## Step-by-Step Application Process Applying is straightforward and can be done via **multiple methods**: download/fax, phone assistance, or digital enrollment. Expect **2-4 weeks** for processing. 1. **Contact Here2Assist**: Call **(844) 817-6468** (Monday-Friday, 8AM-8PM ET, Option 2) or visit **https://www.here2assist.com** for support. 2. **Download the Form**: Get the **Takeda Oncology Here2Assist Enrollment Form** (English/Spanish) from **www.here2assist.com**. It's an interactive PDF. 3. **Complete the Form Together with Your Doctor**: - **Patient Info**: Name, address, financial details (income verification like pay stubs or tax returns). - **Prescriber Info**: Doctor's details, NPI, license, ICD-10 code, Statement of Medical Necessity. - **Insurance Info**: Attach copies of insurance cards. - **Prescription**: Include a valid prescription (fax only; state-specific blanks if required, e.g., NY originals). 4. **Sign with Original Signatures**: **Patient (or legal rep)** and **prescriber** must sign originally—no stamps, scans, or copies. This is critical to avoid delays. 5. **Submit by Fax**: Fax everything to **1-844-269-3038**. Do **not** send medical records or unrequested docs. Mail options may be available via phone. 6. **Alternative: Digital Enrollment**: Some sites allow starting online; your doctor completes by fax/email. **Required Documents**: - Completed **Takeda Oncology Here2Assist Enrollment Form**. - Copy of patient insurance card(s) (both sides). - Valid **prescription**. - Proof of income (as requested in form). ## Timeline and Delivery - **Processing**: **2-4 weeks** after receiving a complete application. Incomplete forms are held, delaying approval. - **Approval Notification**: You'll receive a letter confirming eligibility (up to **1 year** enrollment). - **Delivery**: If approved, **Iclusig** ships **directly to you via specialty pharmacy**. Track with your case manager. - **Refills/Reauthorization**: **Reauthorization required** annually or as needed. Your doctor resubmits updated forms. ## What If You're Denied or Need Alternatives? - **Denied**: Common reasons include sufficient insurance coverage, incomplete docs, or not meeting financial criteria. Contact **(844) 817-6468** for reasons and resubmission guidance. - **Alternatives**: - **Takeda Oncology Co-Pay Program**: For insured patients; may reduce co-pays to $0. - **RapidStart**: For quick access; requires enrollment form on file. - **State Programs**: Check local pharmaceutical aid. - **Generic/Biosimilars**: None available for ponatinib. - **Other PAPs**: PAN Foundation or RxAssist.org for leukemia support. Resubmit with corrections or explore copay cards at **www.takedaoncologycopay.com**. ## Important Disclaimer This guide is for informational purposes based on program details as of latest available info. Eligibility is determined **case-by-case** by Takeda. Rules can change; always verify at **https://www.here2assist.com** or **(844) 817-6468**. Not medical advice—consult your doctor. Takeda disclaims liability for application outcomes. Program not for patients with full coverage.

Program information last verified: March 25, 2026