• Acute lymphoblastic leukemia ICD-10 codes are C91.0, C91.01 and C91.02. View list of ICD-10 codes »
• Primary cancer diagnosis must be the same as the fund and verified by the prescribing physician. Download Physician Verification Form »
• Patient must be insured through a federal health insurance program such as Medicare, Medicaid or TRICARE
• Income level must be at or below 500% of the Federal Poverty Level (FPL)
• Must have a valid Social Security number to apply for assistance and receive treatment in the United States
• Patient must be in active treatment or have a treatment plan in place prior to applying for assistance. Read more in our FAQs »
Apply online or by phone at 866-55-COPAY (866-552-6729)
Initial Grant Amount
Program CAP Amount
If the initial grant amount is exhausted before the grant end date, a request for additional funds up to the program CAP amount can be submitted. Read our Request for Additional Funds policy »Retroactive policy
CCAF will consider retroactive reimbursement on a case-by-case basis for first time applicants actively receiving a covered treatment. Our retroactive assistance will only consider dates of service within 60 days prior to the date we approve the application. Conditional approvals are not eligible for retroactive coverage.
CancerCare offers support services for people with Acute Lymphoblastic Leukemia including counseling, support groups, financial assistance, workshops and publications.