Patients, their family members, or their advocates may apply for assitance from Cancer Copay Relief.
Please review our eligibility section to confirm you or your loved one is eligible (Listed below is a short overview of the eligibility requirements):
- Who is Eligible: Cancer Copay Relief accepts applications from any citizen of the United States with a documented cancer diagnosis. Grants are awarded based on the participant's need and the amount of funding available.
- How it Works: Once your completed application has been received, our staff will verify the information and determine whether or not we are currently able to award assistance. Award letters are sent out as soon as possible.
Before you contact us, please have the following information available:
- Patient Information (name, address, telephone number, social security number, date of birth)
- Patient Insurance Information or Insurance Card
- Patient Income Information (total household income and number of people in the household including the patient)
- Your doctor's (prescribing physician) information (name, address, telephone number and contact name)
- The medications or drug names prescribed to you
If you are unclear about any of these items, go to Step 2 and contact us directly.
Download and complete the application.