Enroll your patient in the NINLARO Co-Pay Assistance Program

Eligible patients may pay as little as $25 for their NINLARO prescription,
up to $25,000 a year. Fill out the form below to get started.

Please be aware that the information you provide about your patient will be used by companies working with Takeda Oncology for the purposes of evaluating and continually confirming your patient’s eligibility for the NINLARO Co-Pay Assistance Program. In addition, Takeda Oncology, and companies working with Takeda Oncology, will have access to the patient information you provide and the information that is obtained through use of the co-pay card during your patient’s participation in this program and other optional programs your patient signs up for. Please review Takeda Oncology's privacy policy available here.

*Required field.

*Please Enter Your NCPDP 7-digit Code

*Patient's First Name

*Patient's Last Name

*Patient's Street Address – Line 1

Patient's Street Address – Line 2

*Patient's City

*Patient's State

*Patient's ZIP Code

*Patient's Date of Birth

Patient's Email Address

Confirm Email Address

*Patient's Phone Number

*Patient's Gender

Opt-in for additional programs.

*My patient is interested in learning more about programs that provide personalized education and support for people who are taking NINLARO and would like to be contacted further by Takeda Oncology or its third parties.

*Takeda Oncology, its affiliates, service providers, and co-promotion partners would like to occasionally send your patient product and disease-state information. Does your patient give permission to use their personal information for these purposes?

Your patient may revoke their permission at any time by contacting the NINLARO Co-Pay Assistance Program at 1-855-902-6725, 8 AM-8 PM ET, Monday through Friday.

Program participants who meet all Program eligibility requirements will pay the first Twenty-five Dollars ($25.00) of their co-pay amount and Takeda will pay the remaining co-pay or co-insurance for each NINLARO® (ixazomib) prescription, up to a maximum of Twenty-five Thousand Dollars ($25,000.00) annually per patient. Program participants will be responsible for any remaining co-pay or co-insurance balance for each prescription. Eligible patients will be eligible for the co-pay assistance up to the maximum amount for a period of twelve (12) months, which begins when a patient enrolls and ends twelve (12) months later. Patients must re-enroll every twelve (12) months in order to maintain eligibility. Restrictions may apply.