How to ApplyPAN offers two easy ways to apply for co-payment assistance:

Online:

panfoundation.org

Phone:

866-316-7263

Application ChecklistThe following information is required:

» Diagnosis and medication name

» Demographics

» Income information

» Type of insurance

» Physician information

Apply Todaypanfoundation.org

or call 866-316-7263

The PAN Foundation is your

go-to resource for assistance

with out-of-pocket costs for

medications and treatment.

If you, or someone you care

for, are living with a life-

threatening, chronic or

rare disease and are having

trouble covering treatment

costs, turn to us to get the

help you need.

Need help covering the cost of your treatment?

We can help

Are you eligible for assistance?

Our programs are updated frequently. Visit our website for status updates and new additions.

AcromegalyAcute Myeloid LeukemiaAmyloidosisAnkylosing SpondylitisArrhythmia in Patients with Atrial Fibrillation or Atrial FlutterAsthmaAtopic DermatitisBasal Cell CarcinomaBladder CancerCarcinoid SyndromeChronic Iron or Lead OverloadChronic Lymphocytic LeukemiaColorectal CancerCushing’s Disease or SyndromeDiabetic Foot UlcersFabry DiseaseGaucher DiseaseGlioblastoma MultiformeHeart FailureHemophiliaHepatitis CHIV Treatment and PreventionHomozygous Familial Hypercholesterolemia PremiumHypercholesterolemiaHyperkalemiaImmune Thrombocytopenic PurpuraInflammatory Bowel Disease

Inherited Retinal DiseaseMacular DiseasesMantle Cell LymphomaMelanomaMetastatic Breast CancerMultiple MyelomaMultiple SclerosisNeurotrophic KeratitisNeutropeniaNon-Hodgkin’s LymphomaNon-Small Cell Lung CancerOvarian CancerParkinson’s DiseasePhiladelphia Chromosome Negative Myeloproliferative NeoplasmsPlaque PsoriasisPostmenopausal OsteoporosisProstate CancerPsoriatic ArthritisPulmonary HypertensionRenal Cell CarcinomaRetinal Vein OcclusionRheumatoid ArthritisShort Bowel SyndromeSystemic Lupus ErythematosusTuberous Sclerosis ComplexUveitisVenous Leg UlcersWaldenstrom Macroglobulinemia

Patient Assistance ProgramsWhy turn to PAN for help?

The Patient Access Network (PAN) Foundation is the fastest, most dependable way for you to receive financial assistance with your out-of-pocket costs for critical medical treatment. PAN provides the help you need so that you can start focusing on what matters most—your health. PAN offers:

» Easy online application process

» Instant determination of eligibility

» One-year grants, with potential for renewal

No one offers a broader array of assistance programs than the PAN Foundation. And no one is better suited to help you access the treatment you need.

Call 866-316-7263 to speak with one of our knowledgeable representatives.

1. You must be receiving treatment for the disease named in the assistance program to which you are applying.

2. You must have health insurance that covers your qualifying medication or product.

3. Your medication or product must be listed on PAN’s list of covered medications.

4. Your income must fall at or below the Fed-eral Poverty Level specified by the assis-tance program.

5. You must reside and receive treatment in the United States or U.S. territories.