Lonsurf® (trifluridine and tipiracil) tablets
Patient and Reimbursement Assistance
TaihoPatientSupport.com
PATIENT ASSISTANCE
Taiho Oncology Patient Support
Taiho Oncology Patient Support offers the following services:
• Co-pay support for eligible, privately insured patients. Such patients can receive a Taiho Oncology Patient Support Co-pay Card for help with out-of-pocket expenses.
• Patient Assistance Program. Taiho Patient Support will research financial assistance options for patients with no insurance coverage, insufficient prescription coverage, or insufficient resources to pay for treatment with Lonsurf. Eligible patients may receive Lonsurf at no cost based on assistance, financial, and medical criteria.
• Alternate funding support. Taiho Patient Support will also refer eligible, publicly insured patients to nonprofit foundations that may be able to offer them co-pay assistance.
To enroll in Taiho Oncology Patient Support simply download the enrollment form in English at:taihopatientsupport.com/Home/ViewPef or Spanish at: taihopatient support.com/Home/ViewPefSp and fax the completed form to 1.844.287.2559.
Questions? Call 844-TAIHO-4U (844.824.4648) Monday through Friday, 8:00 am to 8:00 pm EST. Or visit: taihopatientsupport.com.
REIMBURSEMENT ASSISTANCE
Taiho Oncology Patient Support
Taiho Oncology Patient Support will quickly investigate each patient’s coverage for Lonsurf and help them get access to the Lonsurf treatment they have been prescribed. Taiho Oncology Patient Support offers the following services to help improve access to Lonsurf, and to make the treatment process as simple and smooth as possible:
- Access and reimbursement support, including benefit investigations, assistance with prior authorizations to meet payer requirements, and claims appeals assistance if coverage
- Specialty pharmacy prescription coordination, including prescription triage, coordination with the in-network specialty pharmacy, self-dispensing practice, or hospital retail pharmacy, and claims appeals assistance if coverage is denied.
•Personalized nurse support is available for treatment plan adherence upon request. Taiho Oncology Patient Support treatment plan adherence services are available as needed to support patient care, including refill reminders.
To enroll in Taiho Oncology Patient Support simply download the enrollment form in English at: taihopatientsupport.com/Home/ViewPef or Spanish at: taihopatient support.com/Home/ViewPefSp and fax the completed form to 1.844.287.2559.
Questions? Call 844-TAIHO-4U (844.824.4648) Monday through Friday, 8:00 am to 8:00 pm ET. Or visit: taihopatientsupport.com.
LON-PM-US-0543 06/2016