Patient Terms and Conditions:
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Must be a resident of the US or PR
- Legal residency is not required
- Must have primary commercial insurance that covers the product, and such payer must be the primary payer on each claim
- Must have been prescribed VONJO® (pacritinib) for an FDA-approved indication or a clinical compendia-recognized use
- Must not be receiving other assistance, to include “Not for Profit Foundations” (501c3)
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As required by law, the program is NOT available to individuals who:
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Have coverage or prescriptions paid for in part or full under any state or federally funded
healthcare program including:
- Medicare
- Medicare Advantage Plans
- Medicaid
- Medigap
- Veterans Affairs (VA), Department of Defense (DoD), or TRICARE®
- Other government programs
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Have coverage or prescriptions paid for in part or full under any state or federally funded
healthcare program including:
- Patient must attest to meeting above requirements
- Re-enrollment required every rolling 12 months
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Maximum out of pocket of $25 per month supply for the patient
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If a claim exceeds $10,000, it will reject for review by CTI Access®
- Their phone number will be provided in the rejection for the pharmacy to call
- The CTI Access® team will need to understand the patient’s benefit design to ensure they do have an accumulator policy to approve the claim
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If a claim exceeds $10,000, it will reject for review by CTI Access®
- Maximum contribution by CTI Access®—$25,000 over 12 months
- If a patient maxes out the contribution prior to 12 dispenses, the case/patient must be referred to CTI Access® for review before re-enrollment is allowed