Commercially insured patients may pay as little as $10 for their LEUKERAN®, now through the Waylis Patient Access and Affordability program. Terms and conditions apply.
Commercially insured patients may pay as little as $10 for their prescription*.
Get Your Copay Card:
Your LEUKERAN® Copay Card Information:
Provide this information to your pharmacist to save at the pharmacy.
BIN #: 610600
The program is for:
- Patients with a valid prescription.
- Patients who live in the United States, Puerto Rico, and U.S. Territories. Void where prohibited.
- Patients with a valid commercial prescription plan.
- Please note: This program will not work with government insurance (such as Medicaid, TRICARE, or Medicare Part D). Please select the option below for government insurance.
Medicare / Medicaid / TRICARE
Patients with Medicaid, Medicare, or TRICARE coverage may qualify to receive medication at very little cost or no cost or no cost at all*.
Please download the Patient Assistance Form before to apply and fax to 844-470-1931.
Patients with no insurance coverage may qualify to receive their medication for free*.
Please download the Patient Assistance Form below to apply and fax to 844-470-1931.
For Healthcare Providers
The Waylis Patient Access and Affordability program provides two ways to help your patients save on LEUKERAN®.
Fill out the Patient Assistance Form below and fax to (844) 470-1931.
Copay Card Terms and Conditions:
Offer valid for commercially insured patients who have a valid LEUKERAN® prescription. No substitutions permitted.
Not valid to individuals with Medicare Medicaid, TRICARE or any similar state or federal healthcare programs.
Benefit limited to one use per person for any 30-day period.
Valid only at participating pharmacies.
This offer is non-transferable, no substitutions are permissible, and offer may not be combined with any other coupon, discount, prescription savings card, free trial, or similar offer for specified prescription.
Federal law prohibits the selling, purchasing, trading, or counterfeiting of this Savings Card.
Offer only valid in the United States, Puerto Rico, or other selected U.S. Territories; this offer void in California, Massachusetts or where restricted or prohibited by law.
This offer is not conditioned on any past, present, or future purchase, including refills.
Waylis Therapeutics reserves the right to rescind, revoke or amend the program without notice.
Offer not applicable to co-pays of $10.00 or less.
Eligible patients may pay as little as $10.00 for your prescription. Annual, monthly, and per-fill program limits apply.