Brain Tumor Drug Copayment Assistance Program

The copayment assistance program is now open!

  Click HERE for the application packet
Version 9.0
  Click HERE for the Claim Form
Version 9
  Click HERE for program brochure

Please use our program as a last resort - try the manufacture's program first then use 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
  • 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 usually pays for or allows toward deductible charges for the desired treatment.
  • Are residents of the USA
  • Have income that is not more than shown on the chart below! If you are slightly above but have special circumstances like can not work, send a note telling us why and how much you think you will make this year, and we will consider it.

 Updated 1/1/2020
 # of People in Family  Max Family Income
 1  $62,450
 2  $84,550
 3  $106,650
 4  $128,750
 5  $150,850
 6  $172,950
 7 (or more)  $195,050

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) by having your doctor fill out and sign the "Doctor's Certification Form"
  • Proof of Income Copy of the first 2 pages of your most recent tax return (black out the first 5 numbers of your social security number) 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 tell us what your income is, 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. When we receive bank records they have to be reviewed by our accountant - which adds at least a week to the process and the response is mostly negative since we can not know if that is your only bank account. W9 forms do not really help much - as many people have other sources of income as listed on the tax form. Use this as a last resort - but do not count on it helping.
  • 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 must show: Date dispensed, treatment name, patient responsibility and if patient paid. The charges and amount insurance paid are optional. You tell us on the claim form if we should pay the patient or the pharmacy / provider. We can pay either the pharmacy or the patient - whichever is easier. Most of the time we pay the pharmay directly but we do not use electronic payments so some pharmacies can not bill using a paper form - in that case, you have to pay then we can reimburse you.
  • DO NOT SEND a 1500 CLAIM FORM. We can not use those. Use our claim form!
  • Note that claims must be submitted within 1 month after the end date of your grant, and unused 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.


  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 processed from the new 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 are strongly discouraged - they take way too long to process and go back and forth to verify information. Some patients missed out on grants because the handwriting was not legible. 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, and typing the information, will save a few days and increase your chances of getting approved before the program closes. We can not accept applications when the program is closed - if we held them, the program could never open. At the end of every month, we go over expired grants and reclaim the funds so we might reopen for a few patients. You can contact us or even just send in an application on the first of each month even if the website says the program is closed.

Tip: The easiest way to apply: Click on the Application link above. The application will open on your computer. Fill out the form on your computer - just type into each field. Then print it and sign it. Gather the documents you need: insurance card and first 2 pages of your last tax return. Then bring the entire packet to your doctors office and ask them to fill out the "Certification Form For Physicians" and ask them to fax the entire packet to us.

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.