How to Apply

Applying for co-payment assistance through CancerCare® Co-Payment Assistance Foundation (CCAF) is easy. The first step is to make sure you have read our eligibility requirements and have gathered all the information you will need to present, including:

  • Name
  • Date of birth
  • Phone number
  • Primary/mailing address
  • Social Security Number
  • Number of dependents
  • Household income
  • Primary health insurance provider
  • Diagnosis
  • Product or medication

You, a family member or a representative can contact CCAF directly.

To apply online, go to our PORTAL site.

To apply by phone, call 866-55-COPAY (866-552-6729) and speak with one of our co-payment specialists to see if you are eligible for assistance. Office hours are 9 a.m.–7 p.m. (EST) Monday through Thursday, and 9 a.m.–5 p.m. (EST) on Friday.

If you are eligible to apply, we will mail forms for you and your doctor to complete and return to us. You will need to include documentation to verify your income and insurance.

To learn more, view our application checklist. If you have questions, please visit our Frequently Asked Questions or contact us.