Poteligeo

Indicated For

mycosis fungoides, Sézary syndrome, CTCL, PTCL

About This Medication

# Kyowa Kirin Cares Patient Assistance Program Patient Guide: How to Get Poteligeo (mogamulizumab-kpkc) at Low or No Cost Poteligeo (mogamulizumab-kpkc) is an FDA-approved intravenous medication used to treat certain types of relapsed or refractory T-cell lymphomas, such as mycosis fungoides or Sézary syndrome in adults who have received prior systemic therapy. The **Kyowa Kirin Cares Patient Assistance Program** provides **Poteligeo at no cost** to eligible uninsured U.S. residents meeting income criteria, helping patients facing high treatment costs access this important therapy[1][3][4]. ## Who Qualifies for the Program? This program is designed for patients who lack insurance coverage and have limited financial resources. Key eligibility requirements include: - **Residency**: You must be a permanent resident of the United States, including Puerto Rico and U.S. territories[1][5][10]. - **Insurance Status**: Fully uninsured with **no active medical or pharmacy benefit insurance**. Medicare Part D, Medicaid, Tricare, or other government insurance typically disqualifies you, though select patients with financial/medical hardship may request an exception on a case-by-case basis[1][3][4][5]. - **Prescription**: Poteligeo must be prescribed by a licensed U.S. healthcare professional for an FDA-approved indication[1]. - **Income**: Household income must meet program financial criteria, assessed individually. Sources indicate a threshold around **≤400% of the Federal Poverty Level (FPL)**, though exact figures are not publicly detailed and require application review[5]. Proof of income is mandatory. If you have any insurance—even minimal coverage—you likely won't qualify for free medication through this PAP. However, insured patients may explore separate co-pay assistance options by calling the program[4]. ## About Poteligeo (mogamulizumab-kpkc) **Poteligeo** is a monoclonal antibody that targets CCR4, a protein on certain cancer cells, helping your immune system fight T-cell lymphomas. It's given as an IV infusion, typically every week initially, then less frequently. Common side effects include rash, infusion reactions, diarrhea, and fatigue—discuss risks with your doctor. This program covers the medication cost, but administration fees at infusion centers are your responsibility unless covered elsewhere[3][4]. Always follow your healthcare provider's guidance. ## Income Eligibility Breakdown Specific income thresholds aren't listed publicly and vary by household size; applicants are evaluated case-by-case based on gross annual household income[1][5]. One source notes eligibility for incomes **≤400% FPL** for similar programs[5]. Use the table below for a general guide to 400% FPL (2026 guidelines; confirm current FPL at HHS.gov). Submit documents like tax returns, W-2s, 1099s, pay stubs, or a notarized no-income letter for review[6]. | Household Size | 100% FPL | 400% FPL (Estimated Threshold) | |---------------|----------|-------------------------------| | 1 | $15,060 | $60,240 | | 2 | $20,440 | $81,760 | | 3 | $25,820 | $103,280 | | 4 | $31,200 | $124,800 | *Notes: Add ~$5,380 per additional person for FPL. Exact program limits may differ; call (833) 552-2737 for details[1][5][6].* ## Insurance Requirements - **Uninsured Only**: No health insurance or prescription drug coverage whatsoever[1][3]. - **Medicare Part D**: Not eligible[program details]. - **Government Insurance**: Generally ineligible (e.g., Medicaid, Tricare), but hardship exceptions possible—call to inquire[4][5]. - **Verification**: Your doctor or you authorize release of insurance info for verification[1]. ## Step-by-Step Application Process 1. **Discuss with Your Doctor**: Confirm Poteligeo is appropriate. Download the enrollment form from kyowakirincares.com or poteligeohcp.com[2][3]. 2. **Complete the Form**: Fill all sections—patient info (name, DOB, SSN, address), financial details (household income/size), prescriber info, and insurance status. Your doctor must sign[1][2]. 3. **Gather Documents**: - Proof of residency (e.g., utility bill, driver's license). - Proof of income (tax returns, W-2/1099, pay stubs, Social Security statement; notarized letter if no income). - Valid prescription for Poteligeo. - Proof of no insurance (e.g., denial letter)[program details][6]. 4. **Submit**: Fax to **844-267-5848** (M-F, 8AM-8PM ET). Or call **(833) 552-2737** for help[1][2][10]. Patient or authorized rep must authorize info release[1]. 5. **Benefits Investigation (BI)**: Case manager reviews within ~2 business days, faxes summary or calls if needed[2]. ## Timeline and Delivery - **Processing**: Individual assessment upon full application receipt; BI in 2 business days[1][2]. Full approval timeline not specified—expect 1-2 weeks; call for status. - **Delivery**: If approved, medication ships **directly to you** (or your home)[program details]. Reauthorization required periodically[program details]. - **Refills**: New form or process likely needed; confirm with case manager[1]. ## Alternatives if Denied - **Appeal**: If denied due to income/insurance, provide more docs or request hardship review[4][5]. - **Other Programs**: Check PAN Foundation, Patient Access Network, or NeedyMeds for lymphoma aid. Insured? Co-pay program at (833) 552-2737[3][4]. - **Manufacturer Contact**: Call Kyowa Kirin Cares for external support options[3]. - **No Biosimilars**: None available for Poteligeo[program details]. ## Important Disclaimer This guide is for informational purposes based on available sources as of 2026. Eligibility, terms, and availability can change—**always verify directly with Kyowa Kirin Cares at (833) 552-2737 or via official sites**. Not medical/financial advice. Consult your doctor for treatment decisions. Program doesn't cover administration, travel, or other costs. Kyowa Kirin reserves assessment rights; approval not guaranteed[1][3][5]. (Word count: 1028)

Program information last verified: March 30, 2026