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For ELZONRIS claims reimbursement, complete the Claim Submission Form.

To start your enrollment into the ELZONRIS Co-pay Card Program,
please answer the following questions:

See Terms & Conditions.

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Terms and Conditions:

By using this co-pay card or by mailing in this rebate, you acknowledge that you currently meet the eligibility criteria and will comply with the terms and conditions described below:

  • Patients are not eligible to use this card or participate in the rebate program if they are using a state or federally funded insurance program to pay for their medication, including but not limited to Medicare, Medicaid, TRICARE, Veterans Affairs health care, a state prescription drug assistance program, or the Government Health Insurance Plan available in Puerto Rico.
  • Patient must have private insurance. Offer is not valid for cash-paying patients.
  • With this card, eligible patients will pay a $0 co-pay per eligible monthly prescription, subject to a maximum amount of $25,000 per product per calendar year and a per fill maximum of $9,500 . The amount of any benefit is the difference between your co-pay and $0 . After the annual maximum of $25,000 per product is reached, you will be responsible for the remaining monthly out-of-pocket costs.
  • This co-pay card and rebate are not valid when the entire cost of your prescription drug is eligible to be reimbursed by your private insurance plan or other private health or pharmacy benefit programs.
  • You must deduct the value of this co-pay card or value received under this rebate from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf.
  • This co-pay card and rebate are not valid where prohibited by law.
  • Third-party discount cards and other non-insurance plans are not valid as primary payers under this offer. This offer and rebate cannot be combined with any other savings, free trial, or similar offer for the specified prescription.
  • Card will be accepted only at participating pharmacies.
  • This card and rebate are not health insurance.
  • Offer good only in the U.S. and Puerto Rico.
  • Card is limited to 1 per person during this offering period and is not transferable.
  • No other purchase is necessary.
  • Data related to your redemption of the co-pay card and/or rebate may be collected, analyzed, and shared with Stemline for market research and other purposes related to assessing Stemline’s programs. Data shared with Stemline will be aggregated and de-identified; it will be combined with data related to other co-pay card redemptions and will not identify you.
  • Stemline reserves the right to rescind, revoke, or amend this offer and rebate program without notice.
  • For questions, call 1-800-519-2140.
  • If your pharmacy does not participate in the co-pay program, you may be able to submit a request for a rebate in connection with this offer:
    • Mail a copy of the patient’s original pharmacy receipt indicating patient name, name of medication purchased, price paid, and date purchased, accompanying your prescription, as proof of purchase, along with a copy of the patient’s Stemline Co-Pay Savings Card, to: StemlineARC Co-Pay Savings Program, Attn: Claims Processing Department, 430 Mountain Ave., Suite 105 New Providence, NJ 07974. Receipt will not be returned.
      • The patient will receive a maximum of $25,000 per product per calendar year and a per fill maximum of $9,500 or the amount of the co-pay paid, whichever is less.
      • Rebate will be mailed to patients approximately 6 to 8 weeks after receipt of required documentation or earlier, as required by law.
About ELZONRIS® (tagraxofusp-erzs)

ELZONRIS is a prescription medicine used to treat blastic plasmacytoid dendritic cell neoplasm (BPDCN) in adults and pediatric patients 2 years and older.

IMPORTANT SAFETY INFORMATION

ELZONRIS can cause serious side effects, including:

  • Capillary Leak Syndrome (CLS). ELZONRIS can cause fluid to leak from small blood vessels into your body’s tissues. This is called “Capillary Leak Syndrome.” CLS can quickly cause you to have symptoms that may become life-threatening or fatal (ie, lead to death). Get emergency medical help immediately if you develop any of the following symptoms:
    • fast weight gain
    • swelling of your face, arms, hands, legs, or feet
    • shortness of breath or difficulty breathing
    • low blood pressure (dizziness or lightheadedness, headache, feeling tired, or shortness of breath)

Weigh yourself daily. Your healthcare provider will check your weight and test your blood before you receive each dose of ELZONRIS and as needed during treatment.

  • Hypersensitivity reactions may occur with ELZONRIS. Symptoms may include rash, itching (pruritus), wheezing, or swelling in your face, including around your eyes and/or in and around your mouth
  • Liver damage is usually detected through blood tests. Symptoms may include feeling tired (fatigue), loss of appetite, yellowing of your skin or the whites of your eyes (jaundice), or upper right abdominal pain or discomfort

Your healthcare provider will periodically test your blood while you are on ELZONRIS to check for liver damage.

Contact your healthcare provider immediately if you have any of these symptoms.

Getting medical treatment right away may help keep these problems from becoming more serious.

If you have any side effects during treatment with ELZONRIS, your healthcare provider may hold your treatment for a period of time or completely stop your treatment with ELZONRIS.

The most common side effects of ELZONRIS include CLS, nausea, feeling tired (fatigue), swelling in your legs or feet, fever, and weight gain.

These are not all of the possible side effects of ELZONRIS. If any new side effects start or an existing one gets worse, contact your healthcare provider immediately. For more information, talk to your treatment team.

Be sure to tell your treatment team about:

  • all of your medical conditions, including if you
    • are pregnant or plan to become pregnant. ELZONRIS may harm your unborn baby
      • If you are a female who can become pregnant, you should use effective birth control during ELZONRIS treatment and for 1 week after the last dose
      • Tell your healthcare provider right away if you become pregnant during treatment with ELZONRIS
    • are breastfeeding or plan to breastfeed. It is not known if ELZONRIS passes into breast milk. You and your healthcare provider should decide if you will receive ELZONRIS or breastfeed. You should not do both
  • all of the medicines you take, including prescription medicines, over-the-counter medicines, vitamins, and herbal supplements

You can report any side effects to Stemline Therapeutics, Inc. at 1-877-332-7961 or contact the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

Please see full Prescribing Information, including Boxed WARNING, for ELZONRIS to learn more.

The risk information provided here is not comprehensive. To learn more, talk about ELZONRIS (tagraxofusp-erzs) with your healthcare provider or pharmacist. The FDA-approved product labeling can be found here.

Important Safety Information +
About ELZONRIS® (tagraxofusp-erzs)

ELZONRIS is a prescription medicine used to treat blastic plasmacytoid dendritic cell neoplasm (BPDCN) in adults and pediatric patients 2 years and older.

IMPORTANT SAFETY INFORMATION

ELZONRIS can cause serious side effects, including:

  • Capillary Leak Syndrome (CLS). ELZONRIS can cause fluid to leak from small blood vessels into your body’s tissues. This is called “Capillary Leak Syndrome.” CLS can quickly cause you to have symptoms that may become life-threatening or fatal (ie, lead to death). Get emergency medical help immediately if you develop any of the following symptoms: