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Diffuse Large B-Cell Lymphoma Travel

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Program Status

Program closed

Currently Closed – We are no longer accepting or processing applications for new or renewal patients.

 

Assistance Amount

$10,800 per year. Patients may apply for a second grant during their eligibility period subject to availability of funding.

Eligibility Criteria

  1. The patient must be getting treatment for the disease named in the assistance program to which he or she is applying.
  2. The patient must have health insurance that covers his or her qualifying medication or product. 
  3. Patient must be required to travel greater than 20 miles (one way) to receive their prescribed treatment. Exceptions to distance requirements are made for patients living in large metropolitan cities.
  4. The patient’s income must fall at or below 500% of the Federal Poverty Level.
  5. The patient must reside and receive treatment in the United States or U.S. territories. (U.S. citizenship is not a requirement.)

Travel Assistance Program Details

PAN offers travel assistance for patients seeking treatment for Diffuse Large B-Cell Lymphoma Travel. Our Travel Assistance will cover approved transportation, lodging, and ancillary travel expenses and will provide patients with a high-touch service model that assists in the scheduling of their travel needs.

Transportation

  • » The fund will cover air transportation, car services and other modes of travel to medical appointments related to approved therapy as determined by the prescribing physician.
  • » An appointment with the healthcare provider must be scheduled prior to arranging transportation.
  • » Patients must be approved for Travel Assistance at least two business days in advance of the appointment to ensure travel means are available.

Lodging

  • » Sometimes medical appointments require an overnight stay. We will help arrange and cover the expense of lodging for the patient for the approved therapy.

Ancillary Travel Expenses

  • » Our Travel Assistance works with the patient to ensure costs related to approved travel, covering parking, fuel, and meals (if applicable).
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See the list of medications covered in this program
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  • Active Injection Kit D (dexamethasone sodium phosphate/pf)
  • Adcetris (brentuximab vedotin)
  • Adriamycin (doxorubicin hcl)
  • Alkeran (melphalan)
  • Bendeka (bendamustine hcl)
  • Bicnu (carmustine)
  • Bleo 15K (bleomycin sulfate)
  • Bleomycin Sulfate (bleomycin sulfate)
  • Carboplatin (carboplatin)
  • Cisplatin (cisplatin)
  • Cyclophosphamide (cyclophosphamide)
  • Cytarabine (cytarabine/pf)
  • Deltasone (prednisone)
  • Depocyt (cytarabine liposome/pf)
  • Depo-Medrol (methylprednisolone acetate)
  • Dexamethasone Sodium Phosphate (dexamethasone sod phosphate)
  • Dexamethasone-0.9% Nacl (dexamethasone sodium phosphate in 0.9 % sodium chloride)
  • Dexpak (dexamethasone)
  • Doubledex (dexamethasone sodium phosphate/pf)
  • Doxil (doxorubicin hcl pegylated liposomal)
  • Doxorubicin Hcl (doxorubicin hcl)
  • Doxorubicin Hcl Liposome (doxorubicin hcl pegylated liposomal)
  • Eloxatin (oxaliplatin)
  • Etopophos (etoposide phosphate)
  • Etoposide (etoposide)
  • Flo-Pred (prednisolone acetate)
  • Gemcitabine Hcl (gemcitabine hcl)
  • Gemzar (gemcitabine hcl)
  • Ifex (ifosfamide)
  • Ifosfamide (ifosfamide)
  • Ifosfamide-Mesna (ifosfamide/mesna)
  • Leucovorin Calcium (leucovorin calcium)
  • Lipodox (doxorubicin hcl pegylated liposomal)
  • Locort (dexamethasone)
  • Marqibo (vincristine sulfate liposomal)
  • Matulane (procarbazine hcl)
  • Melphalan Hcl (melphalan hcl)
  • Mesna (mesna)
  • Mesnex (mesna)
  • Methotrexate Sodium (methotrexate sodium/pf)
  • Methylprednisolone (methylprednisolone)
  • Millipred (prednisolone)
  • Mitoxantrone Hcl (mitoxantrone hcl)
  • Navelbine (vinorelbine tartrate)
  • Orapred Odt (prednisolone sod phosphate)
  • Oxaliplatin (oxaliplatin)
  • Ozurdex (dexamethasone)
  • P-Care (methylprednisolone acetate)
  • Pediapred (prednisolone sod phosphate)
  • Prednisolone (prednisolone)
  • Prednisone (prednisone)
  • Prelone (prednisolone)
  • Rayos (prednisone)
  • Revlimid (lenalidomide)
  • Rituxan (rituximab)
  • Rituxan Hycela (rituximab/hyaluronidase, human recombinant)
  • Toposar (etoposide)
  • Treanda (bendamustine hcl)
  • Trexall (methotrexate sodium)
  • Veripred 20 (prednisolone sod phosphate)
  • Vincasar Pfs (vincristine sulfate)
  • Vincristine Sulfate (vincristine sulfate)
  • Vinorelbine Tartrate (vinorelbine tartrate)
  • Xatmep (methotrexate)
  • Zodex (dexamethasone)
  • Zonacort (dexamethasone)

Diagnosis Codes:

ICD-10: C83.30-C83.39

Related Organizations: