Patient Support Programs

Secura Care™ Patient Support Program

For help with insurance verification, co-pay and reimbursement resources, please call:

844-9SECURA [ (844) 973-2872 ]

Monday to Friday 10:00 AM to 7:00 PM ET

Patients are required to sign the Patient Authorization form to give the Patient Support Specialists at Secura Care permission to access personal health information. Personal health information will be used to help with treatment, and will be kept confidential. The authorization form can be signed and submitted online, or by downloadable PDF, which must be printed, filled out, signed, and faxed.

Patients, Sign and Submit

Download or Submit Online

Or Download and Print

Enrollment Form

Copay Card Enrollment

Click Here

For more information on our therapies, please click on the links below to view our product specific information

  • Multiple Myeloma (MM)
Click Here

  • Chronic Lymphocytic Leukemia (CLL) / Small Lymphocytic Lymphoma (SLL)
  • Follicular Lymphoma (FL)
Click Here