Co-Pay Assistance Grants

Ancora Cancer Foundation is a recently-formed charitable organization dedicated to the aid and support of cancer patients and their families. Our Mission Statement is as follows:

Our mission is to provide education about the devastating financial impact of cancer on patients and their families. We act to soften the financial implications of cancer by publishing helpful information offering solutions and by providing direct financial assistance through co-pay grants for chemotherapy and targeted-therapy drugs, as well as cancer patient family crisis stipends for travel and lodging relating to treatment stays. Our actions will provide knowledge, choices, hope and dignity to cancer patients and their families. We also support cancer research and advocacy groups by charitable donations and targeted grants.

Pending approval of the Foundation’s 501(c)(3) application, Ancora Cancer Foundation has limited resources which allow it to serve a restricted number of eligible cancer patients who meet our Eligibility, Medical and Insurance Requirements. The Foundation anticipates that it will receive formal recognition of charitable status by the end of the first quarter 2017. Upon receipt of formal 501(c)(3) status, the Foundation anticipates having substantial financial capacity to assist many cancer patients and their families.

Eligibility

Applying patients must complete and sign an application and HIPAA Authorization form, as well as provide proof of income. We will review your application and forms to the extent that funding is available.

Please note: As a nonprofit organization, we cannot guarantee that funding will always be available for a particular diagnosis. View current covered cancer diagnoses. If we are unable to provide co-payment assistance, however, we will refer you to other organizations that may be able to help.

To qualify for assistance, you must meet certain financialmedical and insurance criteria.

Financial

  • Individuals or families with an adjusted gross income of up to four times the federal poverty level may qualify for assistance. Income verification is required as part of the application process.
  • You must have private insurance or Medicare that covers a portion of the prescribed chemotherapy or targeted treatment.

Medical

  • You must be diagnosed with one of the cancer types that Ancora Cancer Foundation currently covers. The treating doctor must submit a verification form confirming your diagnosis and medications. Your diagnosis must be verified by a doctor. Your doctor must complete and sign our physician verification form.
  • You must currently be undergoing chemotherapy or prescribed and/or using a targeted treatment drug when you apply to Ancora Cancer Foundation, and at the time of approval.
  • Covered types of cancer are: 
  1. Advanced, Recurrent and Metastatic Breast Cancer
  2. Brain Tumors such as Glioblastoma Multiforme
  3. Advanced Hodgkin’s Lymphoma
  4. Advanced, Relapsed Multiple Myeloma
  5. Advanced, Acute Lymphoblastic and Myeloid Leukemias
  6. Advanced, Solid Carcinomas with Bone or Organ Metastasis
  7. Non Small Cell Lung Cancer
  8. Advanced Colon and Colo-Rectal Cancer
  9. Gastrointestinal Stromal Tumor Cancer
  10. Pancreatic Cancer
  11. Advanced Hormone Refractory Prostate Cancer
  12. Advanced Lung Cancer
  • Eligible Drugs are:
  1. Provenge (Sipuleucel-T)
  2. Xofigo
  3. Marquibo
  4. Xgeva
  5. Halaven
  6. Kadcyla
  7. Adcetris
  8. Kyprolis
  9. 5-FU
  10. Leucovorin
  11. Xeloda
  12. Cyramza
  13. Lonsurf
  14. Capecitabine
  15. Oxaliplatin
  16. Irinotecan
  17. Avastin
  18. Stivarga
  19. Erbitux
  20. Vectibix
  21. Zaltrap

Insurance

  • You must be covered by private insurance or an employer-sponsored health plan, or you must have Medicare Part B, Medicare Part D or a Medicare Advantage Plan (Medicare C).

Please note: If you have private insurance, before you contact the Ancora Cancer Foundation, please contact the drug company that manufactures your medication. Drug companies have several programs that may help you.

If you are uninsured (do not have any health or major medical insurance), we will refer you to other organizations which may be able to help.

Other

  • You must be receiving treatment in the United States.
  • You must be a U.S. citizen or legal resident.

Eligible individuals will receive an application packet with instructions on how to apply for assistance. Our Foundation staff members are available if you have any questions about this process.

If we currently do not have funding for your diagnosis, please request a copy of the Foundaton’s Financial Resource Guide for Cancer Patients and their Families.

 

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