Patients and healthcare professionals can now apply for oncology medications on behalf of their uninsured patients living with specific forms of cancer. Check to see if you or your patient qualifies.
Our application takes under 10 minutes to complete
Print out or apply online to see if you qualify
Fill in this application
Fax (1-866-813-6011) or mail us (HarborPath Oncology PAP, 8000 Corporate Center Drive, Suite 200, Charlotte, NC 28226) the signed and completed form
100% HIPAA compliant
HarborPath will follow up
Apply today
What medications are available?
Currently, Emend, Keytruda, Noxafil, Welireg, and Zolinza are available.
What are the program requirements?
You must not have medical insurance (government or private). You must live in the United States. You must meet income guidelines established by our pharmaceutical partners.
What if I have insurance but my insurance doesn’t cover this medicine?
Unfortunately, this program is for uninsured individuals only.
Can the medicine be shipped to my house?
Some medicines can be shipped to your home, but others, such as infusion medicines that go in an IV, can only be shipped to your clinic.
You don’t have the medication I need. Can you get it?
Our goal is to offer as many common medicines as possible. Check back to see if we’ve added the one you’re looking for.
Why do I have to mail or fax my application?
Signatures from you and your provider are required for this program.
If I apply electronically, is my information safe?
Our software suite is HIPAA compliant and we will never share your information with anyone other than the pharmacy that fills your order.
Where do I mail my completed and signed application?
Fax to 866-813-6011 OR mail the completed form to HarborPath Oncology PAP, 8000 Corporate Center Drive, Suite 200, Charlotte, NC 28226
Pharmaceutical manufacturers provide medication to help those who are uninsured. These are referred to as patient assistance programs (PAP). We collaborate to bring together these multiple programs to create a simple, easy application process for hospitals and clinics to help their patients gain access to our database of therapeutic medications.
We are always here to help
