Cancer Patients Save on Select Medications
Cancer treatments can impact a woman’s fertility. Fortunately, fertility preservation options exist, but generally the costs are not covered by insurance. ReUnite Oncofertility helps to reduce the costs for fertility preservation by offering a discount of up to 100% on select medications. The discount a patient receives is determined by her level of financial need.
- Follistim AQ Cartridge (follitropin beta injection) – Limit of 2700 IU
- Ganirelix Acetate Injection (brand name) – Limit of 5 syringes
- Pregnyl (chorionic gonadotropin for injection, USP) – Limit of 1 vial
- Female patient requiring cancer treatments affecting her fertility
- No prior chemotherapy
- Completed Oncologist Form
- Current proof of income (IRS 1040 tax form)
- Download the Oncologist Form and ask your oncologist to complete the form to certify your eligibility.
- Apply online. You will be asked to upload the completed Oncologist Form and a current IRS 1040 tax form.
- Submit your enrollment application. You will receive an email notification within 24-48 hours regarding your application status.
ReUnite Oncofertility Oncologist Form
For more information about this program, call 1-800-515-3784 or email firstname.lastname@example.org.