Pepaxto

Indicated For

Relapsed or refractory multiple myeloma

About This Medication

# Pepaxto (melphalan flufenamide) Patient Guide: How to Get Pepaxto at Low or No Cost **Important Notice: Pepaxto (melphalan flufenamide) is no longer available through any patient assistance program.** The FDA withdrew its approval on February 23, 2024, because confirmatory studies did not verify clinical benefit and safety concerns were identified.[2] Oncopeptides AB, the manufacturer, has ceased promotion and distribution.[1][2] This guide explains the situation and provides alternatives for multiple myeloma patients.[2] ## About Pepaxto Pepaxto was an intravenous chemotherapy drug used with dexamethasone to treat adults with relapsed or refractory multiple myeloma who had received at least four prior therapies, including one proteasome inhibitor, one immunomodulatory agent, and one CD38-directed antibody.[1][2][5] It received accelerated FDA approval in February 2021 based on response rates from the HORIZON trial, but continued approval depended on confirmatory trials that failed to show benefit.[2] Common administration was 40 mg IV on day 1 with dexamethasone orally on days 1, 8, 15, and 22 of a 28-day cycle.[2] **Why was it withdrawn?** The FDA determined Pepaxto did not demonstrate safety or effectiveness under its labeled conditions, leading to full withdrawal.[2] No patient assistance programs are currently active, as the drug is not marketed.[1][7] ## Who Qualifies for Assistance? No one qualifies for Pepaxto assistance today due to its withdrawn status.[2] Previously, Oncopeptides mentioned patient support including financial aid and insurance navigation upon commercial launch in 2021, but these ended post-withdrawal.[4][7] General multiple myeloma co-pay programs like Patient Advocate Foundation (PAF) may help with other treatments.[3] ## Income Eligibility Specific income thresholds are unavailable, as no program exists.[1] Past programs typically used Federal Poverty Level (FPL) guidelines (e.g., 400-500% FPL), but this does not apply now. | Household Size | Typical Past Threshold (e.g., 400% FPL) | Current Status | |---------------|---------------------------------------|---------------| | Individual | ~$58,320/year | Not applicable | | Couple | ~$78,880/year | Not applicable | | Family of 3 | ~$99,440/year | Not applicable | | Family of 4 | ~$120,000/year | Not applicable | *Note: Figures are illustrative based on 2024 FPL; Pepaxto program is defunct.*[1] ## Insurance Requirements Previously, assistance targeted uninsured or underinsured patients.[7] Medicare, Medicaid, and commercial plans had prior authorization criteria matching FDA labeling (e.g., 18+, relapsed/refractory MM, ECOG 0-2).[5] Post-withdrawal, insurers do not cover Pepaxto.[2] ## Step-by-Step Application Process **There is no application process.** Contact your doctor or Oncopeptides (no active contacts listed post-2024) to confirm.[1][2] Instead: 1. Discuss alternatives with your oncologist. 2. Explore general assistance via PAF or myeloma.org.[3] 3. Check Medicaid pharmacy programs, though Pepaxto is off-formulary.[1] ## Timeline and Delivery Processing time, delivery: N/A. Previously, support was multichannel but now discontinued.[4] ## Alternatives if Denied (or Unavailable) - **Other MM therapies:** Pomalyst, Kyprolis, Darzalex, or bispecific antibodies like Tecvayli/Elrexfio. - **Assistance programs:** PAF co-pay fund, PAN Foundation, or manufacturer programs for active MM drugs.[3][9] - **Clinical trials:** Search clinicaltrials.gov for relapsed MM studies. - **Financial aid:** NeedyMeds.org, RxAssist.org for MM support. Consult your healthcare team for personalized options.[1][2] ## Disclaimer This guide is for informational purposes only and not medical advice. Pepaxto's withdrawal means no low/no-cost access via assistance.[2] Eligibility, availability change; verify with providers. As of 2026, no revival indicated. Speak to your doctor before any treatment changes. Information sourced from FDA, state health docs, and historical announcements.[1][2][5]

Program information last verified: March 30, 2026