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 »
We recommend using Google Chrome to avoid possible issues.
Apply online or by phone at 866-55-COPAY (866-552-6729)
Retroactive policyCCAF will consider retroactive reimbursement for first time applicants actively receiving a covered treatment. Our retroactive assistance will only consider dates of service within 60 days prior to the date we approve the application. Conditional approvals are not eligible for retroactive coverage.
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.