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Immune Thrombocytopenic Purpura Travel

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Program Status

Open - We are accepting applications for new and renewal patients. If your application for assistance is approved you can begin receiving funding immediately.

 

Immune Thrombocytopenic Purpura Travel Guidelines »

 

Assistance Amount

$600 per year. Patients may apply for a second grant during their eligibility period subject to availability of funding.

 

Travel Assistance Information

Eligibility Criteria

  1. The patient must be getting treatment for immune thrombocytopenic purpura.
  2. The patient must have Medicare health insurance that covers his or her qualifying medication or product. 
  3. The patient’s medication or product must be listed on PAN’s list of covered medications.
  4. 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.
  5. The patient’s income must fall at or below 400% of the Federal Poverty Level. 
  6. The patient must reside and receive treatment in the United States or U.S. territories. (U.S. citizenship is not a requirement.)

 

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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)
  • A-hydrocort (hydrocortisone sod succinate)
  • Azasan (azathioprine)
  • Bivigam (immune globulin,gamm(igg)/glycine/iga greater than 50 mcg/ml)
  • Carimune Nf Nanofiltered (immune globulin,gamm(igg)/sucrose/iga greater than 50 mcg/ml)
  • Cellcept (mycophenolate mofetil)
  • Cellcept (mycophenolate mofetil hcl)
  • Cortef (hydrocortisone)
  • Cortisone Acetate (cortisone acetate)
  • Cuvitru (immune globulin,gamm(igg)/glycine/iga greater than 50 mcg/ml)
  • Cyclosporine (cyclosporine)
  • Cyclosporine Modified (cyclosporine, modified)
  • Deltasone (prednisone)
  • Depo-medrol (methylprednisolone acetate)
  • Dexamethasone Intensol (dexamethasone)
  • Dexamethasone Sodium Phosphate (dexamethasone sodium phosphate)
  • Dexpak (dexamethasone)
  • Doptelet (avatrombopag maleate)
  • Doubledex (dexamethasone sodium phosphate/pf)
  • Flebogamma Dif (immune globulin,gamma (igg)/sorbitol/iga 0 to 50 mcg/ml)
  • Gamastan (immune globulin,gamma(igg)/glycine)
  • Gammagard Liquid (immune globulin,gamm(igg)/glycine/iga greater than 50 mcg/ml)
  • Gammagard S-d (immune globulin,gamm(igg)/glycine/glucose/iga 0 to 50 mcg/ml)
  • Gammaked (immune globulin,gamma(igg)/glycine/iga average 46 mcg/ml)
  • Gammaplex (immune globulin,gamm(igg)/sorbitol/glycin/iga 0 to 50 mcg/ml)
  • Gamunex-c (immune globulin,gamma(igg)/glycine/iga average 46 mcg/ml)
  • Gengraf (cyclosporine, modified)
  • Hydrocortisone (hydrocortisone)
  • Imuran (azathioprine)
  • Medrol (methylprednisolone)
  • Methylprednisolone (methylprednisolone)
  • Methylprednisolone Sodium Succ (methylprednisolone sodium succinate)
  • Millipred (prednisolone)
  • Millipred (prednisolone sodium phosphate)
  • Mulpleta (lusutrombopag)
  • Mycophenolate Mofetil (mycophenolate mofetil)
  • Mycophenolic Acid (mycophenolate sodium)
  • Myfortic (mycophenolate sodium)
  • Neoral (cyclosporine, modified)
  • Nplate (romiplostim)
  • Octagam (immune globulin,gamm(igg)/maltose/iga greater than 50 mcg/ml)
  • Orapred Odt (prednisolone sodium phosphate)
  • Pediapred (prednisolone sodium phosphate)
  • Prednisolone (prednisolone)
  • Prednisolone Sodium Phosphate (prednisolone sodium phosphate)
  • Prednisone (prednisone)
  • Privigen (immune globulin,gamma (igg)/proline/iga 0 to 50 mcg/ml)
  • Promacta (eltrombopag olamine)
  • Rayos (prednisone)
  • Rhophylac (rho(d) immune globulin)
  • Rituxan (rituximab)
  • Sandimmune (cyclosporine)
  • Solu-cortef (hydrocortisone sodium succinate/pf)
  • Tavalisse (fostamatinib disodium)
  • Veripred 20 (prednisolone sodium phosphate)
  • Winrho Sdf (rho(d) immune globulin/maltose)

Diagnosis Codes:

ICD-10: D69.3, D69.42, D69.49, D69.51, D69.59, D69.6

 

About the Disease:

Immune thrombocytopenic purpura (ITP), also known as idiopathic thrombocytopenic purpura, is a disorder that can lead to easy or excessive bruising and bleeding. ITP is a chronic disease that affects the circulatory system.

 

Source: National Institutes of Health

 

Related Organizations: