Stemline Commercial
Co-Pay Program*

Eligible patients may pay as little as $0 for ELZONRIS.

Stemline Patient
Assistance Program

The Stemline Patient Assistance Program provides ELZONRIS to eligible patients who are under- or uninsured. Patients must meet certain criteria to qualify.

Call 1-833-4-STEMLINE (1-833-478-3654)
for more information.

Independent Third-Party
Foundations

Stemline ARC can provide information about independent third-party foundations.

*Patients must meet eligibility criteria. In order to be eligible for the Stemline Commercial Co-Pay Program, the patient must not have government-funded health insurance (eg, Medicare, Medicaid, or any other federal or state program), must be taking ELZONRIS for an FDA-approved indication, and must confirm that they meet all of the eligibility criteria and agree to the rules set forth in the terms and conditions for the program. Patients and healthcare providers are responsible for completing and submitting enrollment forms and coverage or reimbursement documentation. Stemline Therapeutics, Inc. makes no representation or guarantee concerning coverage or reimbursement of any service or item.

To be eligible for this program, insured patients must have exhausted all other forms of patient assistance and meet financial criteria. Insured and uninsured patients must also meet certain eligibility criteria.

Stemline Therapeutics, Inc. does not influence or control the operations or eligibility criteria of any independent charitable assistance foundation and cannot guarantee assistance after information has been provided by Stemline ARC. The information is provided as a resource to patients. The foundations that we discuss with patients are not exhaustive or indicative of Stemline Therapeutics, Inc.'s endorsement or financial support. There may be other foundations to support the patient's disease state.

Stemline Commercial Co-Pay Program Terms and Conditions

By using the Stemline Commercial Co-Pay Program, the patient acknowledges and confirms that, at the time of usage, (s)he is currently eligible and meets the criteria set forth in the terms and conditions described. The Stemline Commercial Co-Pay Program is valid ONLY for patients with commercial (private or nongovernmental) insurance who are taking the medication for an FDA-approved indication. Patients using Medicare, Medicaid, or any other federal or state government-funded program to pay for their medications are not eligible. Patients who start utilizing their government coverage during their enrollment period will no longer be eligible for the program. Patients may pay as little as $0 per month and Stemline Therapeutics, Inc. will pay the remaining out-of-pocket cost up to a maximum of $25,000 per calendar year. Any costs exceeding the maximum of $25,000 are the responsibility of the patient. This Commercial Co-Pay Program is not health insurance or a benefit plan. Distribution or use of the Stemline Commercial Co-Pay Program does not obligate use or continuing use of any specific product or provider. Patient or guardian is responsible for reporting the receipt of all Commercial Co-Pay Program benefits or reimbursement received to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the Commercial Co-Pay Program, as may be required. The commercial Co-Pay Program is not valid for medications the patient receives for free or that are eligible to be reimbursed by private insurance plans or other healthcare or pharmaceutical assistance programs that reimburse the patient in part or for the entire cost of his/her Stemline medication. Patient, guardian, pharmacist, prescriber, and any other person using the Commercial Co-Pay Program agree not to seek reimbursement for all or any part of the benefit received by the recipient through the offer. The Stemline Commercial Co-Pay Program will be accepted by participating pharmacies, physician offices, or hospitals. To qualify for the benefits of this Commercial Co-Pay Program, the patient may be required to pay out-of-pocket expenses for each treatment. This Commercial Co-Pay Program is only available with a valid prescription and cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription. Use of this Commercial Co-Pay Program must be consistent with all relevant health insurance requirements and payer agreements. Participating patients, pharmacies, physician offices, and hospitals are obligated to inform third-party payers about the use of the Commercial Co-Pay Program as provided for under the applicable insurance or as otherwise required by contract or law. The Commercial Co-Pay Program may not be sold, purchased, traded, or offered for sale, purchase, or trade. The Commercial Co-Pay Program is limited to 1 per person during this offer period and is not transferable. Program eligibility period is contingent upon the patient's ability to meet and maintain all requirements as set forth by the program. Stemline Therapeutics, Inc. may periodically verify eligibility and will terminate patients without obligation to pay claims if change to status is detected. This program is not valid where prohibited by law and shall follow state restrictions in relation to AB-rated generic equivalents where applicable (i.e., MA, CA). The patient must be 18 years or older to receive Commercial Co-Pay Program assistance. This Commercial Co-Pay Program is (1) void if reproduced; (2) void where prohibited by law; (3) only valid in the United States and Puerto Rico; (4) only valid for FDA-approved on-label indications of Stemline products; and (5) expires on 12/31/2019. Healthcare providers may not advertise or otherwise use the program as a means of promoting their services or Stemline Therapeutics, Inc. products to patients. Stemline Therapeutics, Inc. reserves the right to rescind, revoke, amend, or terminate the program without notice at any time.

About ELZONRIS® (tagraxofusp-erzs)

ELZONRIS is a prescription medicine used to treat blastic plasmacytoid dendritic cell neoplasm (BPDCN) in adults and pediatric patients 2 years and older.

IMPORTANT SAFETY INFORMATION

ELZONRIS can cause serious side effects, including:

  • Capillary Leak Syndrome (CLS). ELZONRIS can cause fluid to leak from small blood vessels into your body's tissues. This is called “Capillary Leak Syndrome.” CLS can quickly cause you to have symptoms that may become life-threatening or fatal (ie, lead to death). Get emergency medical help immediately if you develop any of the following symptoms:
    • fast weight gain
    • swelling of your face, arms, hands, legs, or feet
    • shortness of breath or difficulty breathing
    • low blood pressure (dizziness or lightheadedness, headache, feeling tired, or shortness of breath)

Your healthcare provider will check your weight and test your blood before you receive each dose of ELZONRIS and as needed during treatment.

  • Hypersensitivity reactions may occur with ELZONRIS. Symptoms may include rash, itching (pruritus), wheezing, or swelling in your face, including around your eyes and/or in and around your mouth
  • Liver damage is usually detected through blood tests. Symptoms may include feeling tired (fatigue), loss of appetite, yellowing of your skin or the whites of your eyes (jaundice), or upper right abdominal pain or discomfort

Your healthcare provider will periodically test your blood while you are on ELZONRIS to check for liver damage.

Contact your healthcare provider immediately if you have any of these symptoms.

Getting medical treatment right away may help keep these problems from becoming more serious.

If you have any side effects during treatment with ELZONRIS, your healthcare provider may hold your treatment for a period of time or completely stop your treatment with ELZONRIS.

The most common side effects of ELZONRIS include CLS, nausea, feeling tired (fatigue), swelling in your legs or feet, fever, and weight gain.

These are not all of the possible side effects of ELZONRIS. If any new side effects start or an existing one gets worse, contact your healthcare provider immediately. For more information, talk to your treatment team.

Be sure to tell your treatment team about:

  • all of your medical conditions, including if you
    • are pregnant or plan to become pregnant. ELZONRIS may harm your unborn baby
      • If you are a female who can become pregnant, you should use effective birth control during ELZONRIS treatment and for at least 1 week after the last dose
      • Tell your healthcare provider right away if you become pregnant during treatment with ELZONRIS
    • are breastfeeding or plan to breastfeed. It is not known if ELZONRIS passes into breast milk. You and your healthcare provider should decide if you will receive ELZONRIS or breastfeed. You should not do both
  • all of the medicines you take, including prescription medicines, over-the-counter medicines, vitamins, and herbal supplements

You can report any side effects to Stemline Therapeutics, Inc. at 1-877-332-7961 or contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.


Please see full Prescribing Information, including Boxed WARNING, for ELZONRIS to learn more.

IMPORTANT SAFETY INFORMATION

About ELZONRIS® (tagraxofusp-erzs)

ELZONRIS is a prescription medicine used to treat blastic plasmacytoid dendritic cell neoplasm (BPDCN) in adults and pediatric patients 2 years and older.

IMPORTANT SAFETY INFORMATION

ELZONRIS can cause serious side effects, including:

  • Capillary Leak Syndrome (CLS). ELZONRIS can cause fluid to leak from small blood vessels into your body's tissues. This is called “Capillary Leak Syndrome.” CLS can quickly cause you to have symptoms that may become life-threatening or fatal (ie, lead to death). Get emergency medical help immediately if you develop any of the following symptoms:
    • fast weight gain
    • swelling of your face, arms, hands, legs, or feet
    • shortness of breath or difficulty breathing
    • low blood pressure (dizziness or lightheadedness, headache, feeling tired, or shortness of breath)

Your healthcare provider will check your weight and test your blood before you receive each dose of ELZONRIS and as needed during treatment.

  • Hypersensitivity reactions may occur with ELZONRIS. Symptoms may include rash, itching (pruritus), wheezing, or swelling in your face, including around your eyes and/or in and around your mouth
  • Liver damage is usually detected through blood tests. Symptoms may include feeling tired (fatigue), loss of appetite, yellowing of your skin or the whites of your eyes (jaundice), or upper right abdominal pain or discomfort

Your healthcare provider will periodically test your blood while you are on ELZONRIS to check for liver damage.

Contact your healthcare provider immediately if you have any of these symptoms.

Getting medical treatment right away may help keep these problems from becoming more serious.

If you have any side effects during treatment with ELZONRIS, your healthcare provider may hold your treatment for a period of time or completely stop your treatment with ELZONRIS.

The most common side effects of ELZONRIS include CLS, nausea, feeling tired (fatigue), swelling in your legs or feet, fever, and weight gain.

These are not all of the possible side effects of ELZONRIS. If any new side effects start or an existing one gets worse, contact your healthcare provider immediately. For more information, talk to your treatment team.

Be sure to tell your treatment team about:

  • all of your medical conditions, including if you
    • are pregnant or plan to become pregnant. ELZONRIS may harm your unborn baby
      • If you are a female who can become pregnant, you should use effective birth control during ELZONRIS treatment and for at least 1 week after the last dose
      • Tell your healthcare provider right away if you become pregnant during treatment with ELZONRIS
    • are breastfeeding or plan to breastfeed. It is not known if ELZONRIS passes into breast milk. You and your healthcare provider should decide if you will receive ELZONRIS or breastfeed. You should not do both
  • all of the medicines you take, including prescription medicines, over-the-counter medicines, vitamins, and herbal supplements

You can report any side effects to Stemline Therapeutics, Inc. at 1-877-332-7961 or contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.


Please see full Prescribing Information, including Boxed WARNING, for ELZONRIS to learn more.