Co-Payment Assistance Fund
Acute Lymphoblastic Leukemia
Helping people with cancer access the prescribed treatments they need.
Program Status:
Open
Grant Amount:
$7,000
Eligibility Criteria
Diagnosis:
• Acute lymphoblastic leukemia ICD-10 codes are C91.0, C91.01 and C91.02. View list of ICD-10 codes »
• Primary cancer diagnosis must be the same as the fund and verified by the prescribing physician. Download Physician Verification Form »
Insurance:
• Patient must be insured through a federal health insurance program such as Medicare, Medicaid or TRICARE
Income:
• Income level must be at or below 500% of the Federal Poverty Level (FPL)
Citizenship:
• Must have a valid Social Security number to apply for assistance and receive treatment in the United States
Treatments Covered:
• Patient must be in active treatment or have a treatment plan in place prior to applying for assistance. Read more in our FAQs »
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Apply online or by phone at 866-55-COPAY (866-552-6729)
Initial Grant Amount
$7,000
Program CAP Amount
$10,000
If the initial grant amount is exhausted before the grant end date, a request for additional funds up to the program CAP amount can be submitted. Read our Request for Additional Funds policy »
Additional Services
CancerCare offers support services for people with Acute Lymphoblastic Leukemia including counseling, support groups, financial assistance, workshops and publications.