Brain Tumor Drug Copayment Assistance Program


We have run out of money - no new applications can be accepted

We can continue to pay patients who were already accepted!

We will announce when we get more funding in our Brain Tumor News Blast

  Click HERE for the application packet
Version 8.0
  Click HERE for the Claim Form
Version 8
  Click HERE for program brochure

Please use our program as a last resort - try the manufactur's program first then call us if you still need help!

 The Brain Tumor Drug Copayment Assistance Program, a program of the Musella Foundation For Brain Tumor Research & Information, Inc., provides financial assistance to families who need help covering the cost of certain drugs used to treat Primary Malignant Brain Tumors (Grade 3 or 4). There is no fee for this assistance, and you will not be obligated to pay it back in any way. We will never tell you which treatment to use, which doctor to use or which pharmacy to use!

Covered Treatments include:

  • Avastin
  • Gliadel
  • Optune (Novocure)
  • Temodar

   The Program's resources are limited, but we will help as many families as possible. We will give awards on a first come first served basis until the funds run out - so apply now. There is a yearly maximum per person of $5,000 - which is subject to change. We may be able to (depending on our fund level) start your coverage date up to 3 months prior to the date you first register. This program is designed to help people who:

  • Have a glioblastoma multiforme, or other type of PRIMARY (NOT METASTATIC) MALIGNANT BRAIN TUMORS (Grade 3 or 4) (Such as Anaplastic Astrocytoma, Gliosarcoma, High Grade Oligodendroglioma, DIPG, Etc), and who use one or more of the drugs covered by the program
  • Have insurance that pays for a portion of the drugs
  • Are residents of the USA
  • Have income that is less than five times higher than the poverty level OR have lost your job due to the brain tumor!

Note that we raised the income limits on 1/1/2016. The brochure and old applications may have the old limits. The limits below are what we are now using!
 # of People in Family  Max Family Income
 1  $58,850
 2  $79,650
 3  $100,450
 4  $121,250
 5  $142,050
 6  $162,850
 7 (or more)  $183,650

This is a spacer - ignore it. No brain tumor content in this image! If you do not meet these qualifications but are having trouble paying for drugs to treat your brain tumor, you may be able to receive financial assistance from other organizations. See our list of resources here.

We will try to make this as easy as possible for you (and your doctor!) but we need to make sure that our limited resources are given to those that need it. To Apply you will need:

  • Proof of Diagnosis of a Glioblastoma Multiforme or other primary malignant glioma. (Grade 3 or 4 only)
  • Proof of Income Copy of the first 2 pages of your most recent tax return is best and will result in the quickest decision and best chance for approval. If you did not file taxes, send a signed letter saying you did not file taxes and include proof of income in some other way - such as SSI disability statements. Note that bank statements are no help at all - please do not send them. You may black out the first 5 digits of your social security number on any documents you send. We only need the last 4 digits!
  • Proof of Insurance that covers the type of treatment you are applying for (Copy of your insurance card)

Once approved, to file a claim you need: (You can send at same time as application or wait until you get a decision)

  • A detailed receipt or explanation of benefits that shows: Date dispensed, treatment name, charges, insurance paid, patient responsibility and if patient paid. You can tell us on the claim form if we should pay the patient or the pharmacy / provider.
  • Proof that you are not applying for assistance from other services for this same prescription. (A simple 'Pharmacy Certification Form' needs to be filled out by the pharmacist or provider)
  • Note that claims must be submitted within 1 month after the end date of your grant, and ununsed funds will be returned to our copayment assistance fund and used to help other brain tumor patients. IF you need more time, contact us before the 1 month period is up.

Renewals:

  When your grant expires, you may apply for a renewal of the grant by sending in the same application as for a new grant - but you do not need to have the  doctor sign the certification form. Just write on it "on file". You need to send proof of income and insurance again. Note that you can't apply until the old grant expires. The new grant can not look back prior to the expiration date of the old grant. For example, if you used up the funds in the first grant and reapply, we can't go back and pay claims from before the first expiration date. Also note that when you apply for a renewal, we have to close out the old grant and take any remaining funds back to reuse on other grants. So if there are any unpaid claims from the old grant, send them along with the application for renewal. If the renewal application is approved before we receive a claim from the old grant, these claims may be denied. In some cases we may be able to process them from the current grant, so tell us if you think there may be more claims coming when you apply!

We encourage you to apply to all of the other sources of assistance first, and use us as a last resort as we have limited funds.

Complete applications are considered in the order in which they are entered into our system. Sending in a partial application does not hold your place. Hand written applications may take a few additional days to process and if we have trouble reading your handwriting we will reject the application and ask you to start over. The forms are designed to allow you to type directly into them. As the program opens and closes quickly, sending the application by fax instead of by email or mail will save a few days and increase your chances of getting approved before the program closes.

To apply, click on the link for the application above and fax or mail it to us.
Call us at 1-855-426-2672 (toll free) if you have any questions.