The Pomalidomide Capsules Savings Program
Commercially insured patients
may pay as little as $0
per prescription.*
*Additional Terms and Conditions may apply, see eligibility requirements below.
- Eligibility
Questions - Savings
Card
Patient Eligibility*
Please answer the following questions to find out if you are eligible for the Pomalidomide Capsules Savings card. In order to receive benefits under the program, it is important that you provide accurate information.
Please select Yes or No.
Please select Yes or No.
Please select Yes or No.
*Please note answers to all questions are required.
- Eligibility
Questions - Savings
Card
Your virtual Savings Card can be seen below. Please record or print the following information and provide it to your pharmacy for financial assistance.
| BIN# |
| PCN# |
| GRP# |
| ID# |
Your Savings Card has been activated.
Unable to Process
We are currently unable to process the request.
Please contact Pomalidomide Savings Program at 1-877-340-2833 and refer to case number -
Success!
You are eligible for a Savings Card.
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