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Patient Access Programs

Shorla is committed to ensuring our products are accessible and affordable for patients.

COPAY SUPPORT FOR COMMERCIALLY INSURED PATIENTS

When prescribed, IMKELDI is available for as little as $15 for commercially insured patients. No cards, coupons, or calls required.

Quick Start Form

QUICK START PROGRAM

Quick Start ensures timely access to treatment to eligible patients with insurance delays.

After three (3) business days, Walgreens assesses eligibility, and if deemed appropriate, triages a Quick Start enrollment form to the prescribing physician .

The program covers a one-month supply while Walgreens continues processing the initial prescription.

Assistance is available via this form or by calling 1-844-9-SHORLA Opt. 5 (1-844-9746752 #5). Shorla Oncology representatives are available to assist you from 8 AM to 5 PM CT.

Patient Assistance Form

PATIENT ASSISTANCE PROGRAM

Assistance is available for uninsured patients via this form or by calling
1-844-9-SHORLA Opt. 4 (1-844-974-6752 #4). Shorla Oncology representatives are available to assist you from 8 AM to 5 PM CT.

  • Mail completed form to:
    EVERSANA
    Shorla Oncology Patient Assistance Program
    17877 Chesterfield Airport Rd
    Chesterfield, MO. 63005
  • FAX: 1 (866) 779-6296
Sample Letter of Medical Necessity

REIMBURSEMENT SUPPORT

Reimbursement support is available by contacting 1-844-9-SHORLA Opt. 3 (1-844-974-6752 #3), where dedicated professionals work to reduce time to fill, improve fulfillment and improve patient experience.

IMKELDI PATIENT ASSISTANCE TERMS AND CONDITIONS:

The IMKELDI Savings Program applies automatically for eligible claims at participating pharmacies. No coupon is needed.

  • The automated Savings Program is a paperless electronic program that automatically applies the discount to your prescription.  
  • This offer is valid for up to 12 months. If you have commercial drug insurance that covers IMKELDI, you can get a 30-day supply for as little as $15.
  • This offer covers up to $575 for a 30-day supply of IMKELDI. Patient is responsible for any applicable taxes, fees, or amounts exceeding monthly caps.
  • Offer void where prohibited by law.
  • This offer is only for patients with commercial drug insurance and is not available if your IMKELDI prescription claims are eligible to be reimbursed, in whole or in part, by any government insurance plan program, including, without limitation, Medicaid, Medicare, Medicare Part D, Medigap, DoD, VA, TRICARE®/CHAMPUS, or any State Patient or Pharmaceutical Assistance Program.
  • This offer is not valid for: Massachusetts residents if an AB-rated generic equivalent becomes available; California residents if an FDA-approved therapeutic equivalent is available.
  • Available only in the US at participating pharmacies for residents of the US.

This offer cannot be combined with any other program, discount, discount card, cash discount card, coupon, incentive, or similar offer involving IMKELDI. Eligibility for this offer is determined at the pharmacy point of dispense, and terms of eligibility may be amended by Shorla Oncology at any time without notice. This offer is not health insurance.

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