For the duration of the Covid-19 Pandemic:
We are relaxing our requirement for the doctor having to sign the application. You can use a copy of your pathology report instead. Write "See pathology report" on the line where the doctor is supposed to sign!
We are also relaxing the income qualification on a case by case basis. If you exceed the limit, and your income is going to be affected by the crisis, write a note explaining how it affects you and what you think your income will be this year and we will evaluate it on a case by cace basis.
Fax is fastest but if you do not have access to a fax you can email the application and/or claims to us at email@example.com. Use "Copayment Program" as the subject. If you do not get an email response from us in 24 hours, contact us to make sure we got it.
We are overwhelemed with applications now - and most are marked emergency. We are running a few days delayed. IF you are approved, we can go back 90 days and reimburse you for covered expenses.
The copayment assistance program is now open!
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:
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. When approved, we can go back 3 months to reimubrse you for any of the covered treatments you already paid for.
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
If you file Tax Form 1040, use the amount on line 6 as income.
| # of People in Family
|| Max Family Income
| 7 (or more)
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
To apply (first time):
- Click on the Application Packet link above. Fill out the form by typing into it on your computer, then print it out, sign it and gather the following documents. Then bring it to your doctor's office, let them fill out the certification form and ask if they can fax the entire packet back to us. That is the fastest way!
- 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 and W2 Forms are usually no help at all
- Proof of Insurance that covers the type of treatment you are applying for (Copy of your insurance card).
To file a claim: (You can send at same time as application or wait until you get an approval of the grant)
- We do NOT do electronic billing - you must use our claim form and send by fax or mail (fax is faster).
- Use the claim form above - click on CLAIM FORM (it is also in the application packet).
- We can NOT pay until the medication is dispensed.
- Get 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 pharmacy directly.
- DO NOT SEND a 1500 CLAIM FORM. We can not use those. Use our claim form!
- The Claim Form asks for the date of birth and the last 4 digits of the social security number. You must enter at least one of these in case we have a patient with the same name!
- 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 to file a claim, contact us before the 1 month period is up.
To apply for renewal of grant:
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.