ZYNLONTA

Indicated For

relapsed or refractory large B-cell lymphoma, DLBCL

About This Medication

# ADVANCING Patient Support Patient Guide: How to Get ZYNLONTA at Low or No Cost ## About This Program ADVANCING Patient Support is a patient assistance program offered by ADC Therapeutics, the manufacturer of ZYNLONTA (loncastuximab tesirine-lpyl). This program is designed to help patients access ZYNLONTA by providing personalized support, including health insurance guidance and financial assistance. All support through this program is completely free—there is no purchase requirement to participate.[1][2] ## What Is ZYNLONTA? ZYNLONTA is a prescription medication used to treat certain blood cancers. Your healthcare provider will determine if ZYNLONTA is appropriate for your specific condition and treatment plan. ## Who Qualifies for Financial Assistance? ADVANCING Patient Support offers two main financial assistance pathways: ### Commercially Insured Patients If you have commercial health insurance and meet eligibility requirements, you may qualify for the **copay assistance program**. Eligible patients can pay as little as **$0 per dose**, with a maximum annual benefit of $25,000 per calendar year.[1][2] **Important eligibility restrictions for the copay program:** - Must be 18 years of age or older - Must have active commercial insurance coverage for ZYNLONTA - Cannot participate in federal or state healthcare programs with prescription drug coverage - Cannot be uninsured or full cash-paying - Additional eligibility requirements and restrictions apply[1][2] ### Uninsured or Underinsured Patients If you are uninsured or underinsured, ADVANCING Patient Support can assess whether you qualify for the patient assistance program to cover your medication costs. Eligibility is determined on a needs-based basis.[1][2] ## Insurance Requirements and Restrictions You are **not eligible** for the copay assistance program if you participate in any of the following federal or state healthcare programs: | Program Type | Examples | |---|---| | Federal Healthcare Programs | Medicare, Medicare Part D, Medicare Advantage | | State Healthcare Programs | Medicaid | | Military/Veterans Programs | VA, DOD, TRICARE | If you are enrolled in any of these programs, you may still be eligible for the patient assistance program if you are uninsured or underinsured. Contact ADVANCING Patient Support to discuss your specific situation.[1][2] ## How to Apply: Step-by-Step ### Step 1: Talk to Your Doctor Your healthcare provider initiates the enrollment process. During your next appointment, ask your doctor to enroll you in ADVANCING Patient Support. Your doctor's office will submit your enrollment information to the program.[1] ### Step 2: Complete Required Forms You will need to complete the following forms: - **Patient Enrollment Form**: Provides your basic information and medical history - **Patient Authorization Form**: Authorizes ADC Therapeutics to access your information - **Patient Assistance Program Consent Form**: Confirms your understanding of the program[1][3] These forms are available in interactive PDF format, allowing you to type information directly. Your doctor's office can help you complete these forms, or you can contact ADVANCING Patient Support for assistance. ### Step 3: Submit Your Application Your completed enrollment forms should be submitted to ADVANCING Patient Support via: - **Fax**: 1-855-915-3005 - **Email**: support@ADVANCINGPatientSupport.com - **Phone**: 1-855-690-0340 (Monday-Friday, 8 AM–8 PM ET)[3] ### Step 4: Benefits Investigation Once your application is received, ADVANCING Patient Support will conduct a benefits investigation to understand your insurance coverage and out-of-pocket costs. A summary of benefits will be provided to you and your healthcare provider.[2] ### Step 5: Eligibility Assessment After the benefits investigation, ADVANCING Patient Support will assess your eligibility for either the commercial copay program or the patient assistance program. Your healthcare provider will receive a fax notification of your eligibility status.[2] ### Step 6: Welcome Call Once enrolled, you will receive a welcome call from ADVANCING Patient Support to introduce you to the program and assign you a dedicated case manager. Save **1-855-690-0340** in your contacts so you recognize the number.[5] ## Your Dedicated Case Manager Upon enrollment, you will be assigned a dedicated case manager who is trained on your specific case. Your case manager can help you with: - Understanding whether ZYNLONTA is covered under your insurance plan - Determining what your out-of-pocket costs may be - Identifying any approvals or additional information needed before you receive therapy - Navigating the financial assistance options available to you[1][5] You can reach your case manager at **1-855-690-0340** (Monday-Friday, 8 AM–8 PM ET). ## Timeline and Medication Delivery While specific processing timeframes are not detailed in the program materials, ADVANCING Patient Support works to process applications efficiently. Once you are approved for assistance, your medication will be shipped to your physician's office for administration.[1] For specific information about processing times for your application, contact your case manager at 1-855-690-0340. ## What If Your Application Is Denied? If you are not approved for financial assistance through ADVANCING Patient Support, your case manager can discuss alternative options with you. The program can also provide you with a list of support organizations and resources that may be able to help.[1] Do not hesitate to ask your case manager about: - Why your application was not approved - Whether you can reapply if your circumstances change - Other financial resources or support organizations ## Important Program Information **Maximum Annual Benefit**: For commercially insured patients in the copay program, the maximum benefit is $25,000 per calendar year (January 1–December 31).[1][2] **No Purchase Requirement**: All support provided through ADVANCING Patient Support is complimentary. You are not required to purchase any medication to participate in the program.[8] **Authorization Changes**: You can revoke your authorization at any time by contacting ADVANCING Patient Support at 1-855-690-0340 or by sending a written request for cancellation.[4] ## Contact Information **ADVANCING Patient Support** - **Phone**: 1-855-690-0340 (Monday-Friday, 8 AM–8 PM ET) - **Fax**: 1-855-915-3005 - **Email**: support@ADVANCINGPatientSupport.com - **Website**: www.ADVANCINGPatientSupport.com ## Disclaimer This guide provides general information about ADVANCING Patient Support. Program eligibility, benefits, and terms are subject to change. For the most current and complete information, including full terms and conditions, visit ADVANCINGPatientSupport.com or contact the program directly. Always consult with your healthcare provider and case manager regarding your specific eligibility and coverage options.

Program information last verified: March 30, 2026