ICLUSIG

Indicated For

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

About This Medication

# Takeda Oncology Here2Assist Patient Assistance Program Patient Guide: How to Get ICLUSIG (ponatinib) at Low or No Cost ICLUSIG (ponatinib) is a targeted therapy used to treat certain types of leukemia, and the **Takeda Oncology Here2Assist Patient Assistance Program** helps **uninsured or underinsured patients** get it at low or no cost if they meet eligibility criteria. ## About ICLUSIG (ponatinib) **ICLUSIG (ponatinib)** is a prescription medication classified as a tyrosine kinase inhibitor. It works by blocking specific proteins that cause cancer cells in certain leukemias to grow and divide. Doctors prescribe it for adults with: - **Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL)** resistant or intolerant to prior tyrosine kinase inhibitor therapy. - **Chronic myeloid leukemia (CML)** or Ph+ ALL with the **T315I mutation**. - **Chronic phase, accelerated phase, or blast phase CML** resistant or intolerant to prior treatments. Always take ICLUSIG exactly as prescribed. Common side effects include high blood pressure, rash, dry skin, headache, abdominal pain, fatigue, constipation, nausea, arthralgia, and pyrexia. Serious risks involve blood clots, heart problems, and liver issues—report symptoms like chest pain or swelling to your doctor immediately. This guide focuses on assistance; full details are in the prescribing information from your healthcare provider. ## Who Qualifies for the Program? The **Takeda Oncology Here2Assist Patient Assistance Program** supports patients facing financial hardship with access to ICLUSIG. Key eligibility includes: - U.S. residents (or legal residents). - **Uninsured or underinsured**, where insurance does not cover the prescribed medication. - Meet financial need criteria (specific income thresholds not publicly detailed; program assesses on a case-by-case basis). - Valid prescription for ICLUSIG from a licensed U.S. healthcare provider. **Note**: Patients with Medicare, Medicaid, or other government insurance may have limited eligibility—check specifics during application. The program does not cover patients with comprehensive commercial insurance that fully pays for the drug. ## Income Eligibility Breakdown Detailed federal poverty level (FPL) thresholds are not specified in program materials, as eligibility is determined individually based on household income, size, and financial hardship. Contact the program for a personalized assessment. Here's a general reference table for 2026 U.S. Federal Poverty Guidelines (for context; program uses its own criteria): | Household Size | 100% FPL | 400% FPL | 500% FPL | |---------------|----------|----------|----------| | 1 | $15,060 | $60,240 | $75,300 | | 2 | $20,440 | $81,760 | $102,200 | | 3 | $25,820 | $103,280 | $129,100 | | 4 | $31,200 | $124,800 | $156,000 | | +1 person | +$5,380 | +$21,520 | +$26,900 | *Source: U.S. HHS guidelines (approximate for 2026). Programs like this often approve up to 400-500% FPL or higher for underinsured. Call (844) 817-6468 for exact review.* ## Insurance Requirements This program targets **uninsured or underinsured patients whose prescribed medication is not covered by insurance**. A **benefits verification** occurs within **2 business days** of form receipt to check coverage and out-of-pocket costs. Submit a copy of your insurance card (front/back). If insured but facing high copays/denials, you may qualify for support. Medicare Part D or Medicaid patients: Assistance may be unavailable or limited—explore other options like Extra Help or state programs first. ## Step-by-Step Application Process Enrollment is straightforward with **multiple methods**: online, download/fax, or phone assistance. Here's how: 1. **Discuss with your doctor**: Confirm ICLUSIG is right for you. Have them help complete the enrollment form. 2. **Gather documents**: - Completed **Takeda Oncology Here2Assist Enrollment Form** (select ICLUSIG, include prescriber/patient info, insurance details, pharmacy preference, prescription request). - **Copy of insurance card** (front/back). - **Valid prescription** for ICLUSIG (fax only). 3. **Choose method**: - **Online**: Visit [www.here2assist.com](https://www.here2assist.com), start digital enrollment—your provider finishes by fax/email. - **Download/Fax**: Get form from [www.here2assist.com](https://www.here2assist.com) (English/Spanish). Doctor and patient **sign with original signatures** (no stamps). Fax all to **1-844-269-3038**. - **Phone help**: Call **(844) 817-6468** (Mon-Fri, 8AM-8PM ET) for guidance. 4. **Submit**: Ensure **original signatures**—incomplete forms delay processing. 5. **Wait for confirmation**: Case manager contacts you post-processing. **Pro tip**: Use the checklist on the form: product, prescriber, patient info, insurance, necessity statement, pharmacy, prescription. ## Timeline and Delivery - **Processing**: Benefits verification in **2 business days**. - **Approval notice**: Case manager calls/emails you and your doctor. - **Enrollment duration**: Up to **1 year** if approved. - **Delivery**: Medication **shipped to you via specialty pharmacy** (they coordinate filling/shipping). Expect a **1-month supply** initially; refills handled through reauthorization. - **Support**: Regular follow-up calls from case managers. **Reauthorization required** annually or as needed—resubmit form before expiration. ## Alternatives if Denied or Ineligible - **Takeda Co-Pay Program**: For commercially insured with high copays—visit takedaoncologycopay.com. - **Other assistance**: PAN Foundation, HealthWell Foundation, or Leukemia & Lymphoma Society for leukemia drugs. - **RapidStart**: For urgent needs, doctor submits separate form post-enrollment. - **Generic/biosimilars**: None available for ponatinib. - **State programs**: Check NeedyMeds.org or RxAssist.org. - **Appeal**: Call program to discuss denial reasons and resubmit. ## Important Disclaimer This guide provides general information based on publicly available program details as of 2026 and is not medical or legal advice. Eligibility, benefits, and terms can change—**always verify with Takeda Oncology Here2Assist at (844) 817-6468 or www.here2assist.com**. Consult your doctor for treatment decisions. Takeda disclaims liability for use of this information. Program availability limited to U.S. residents; void where prohibited.

Program information last verified: March 30, 2026