Valchlor Patient assistance program
Complete a free online enrollment application to find out if you’re eligible to pay only $49 per month for your Valchlor medication with our help.Get Started Now
Secure: Your personal and medical information is safe with us
Convenient: Your medication is delivered straight to your door
Ongoing refills: Your medication is refilled automatically
NiceRx works with your healthcare provider to help you access affordable medications directly from U.S. pharmaceutical companies.
An introduction to NiceRx(01:52)
Next steps after qualifying(00:38)
Uploading documents and billing(00:50)
SSN & billing information(00:33)
Medication delivery time(00:41)
How it works
Get started by filling out the online enrollment application to find out if you are eligible.
NiceRx verifies your eligibility for medication assistance and notifies you if you are qualified. The pharmaceutical company provides your medication for free and you only pay our service fee.
You may be required to submit further information and documents required by the pharmaceutical company which can be securely uploaded online.
Your application is created and sent to your doctor for signature. At this stage, you will be billed $49 and will not be billed again until you receive your first medication delivery.
Your application is sent to the pharmaceutical company. You will be billed again once you receive your medication. We handle the entire ordering process including requesting ongoing refills.
Your monthly Valchlor cost savings if eligible
If you are eligible to receive your Valchlor prescription through the patient assistance program, your medication will be free. We charge a flat monthly service fee of $49 per medication to cover the cost of our services.
Am I eligible for Valchlor patient assistance?
To be eligible for the Valchlor patient assistance program, you will need to meet specific eligibility criteria set by the pharmaceutical company. At NiceRx, we review each Valchlor enrollment application individually. The main factors considered are:
- I am a permanent, legal resident of the United States or Puerto Rico
- I am uninsured or my insurance doesn’t cover my medication
- I meet certain income eligibility requirements
How do I apply for the Valchlor patient assistance program?
Applying for the Valchlor patient assistance program through NiceRx is simple. Begin by completing the enrollment application on our website. We will ask for details about your healthcare provider, your insurance plan, and your household income. This information is required by the pharmaceutical manufacturers that supply your medication. We may be able to help you access patient assistance for other medications as well as Valchlor, so please tell us about any medications that you have been prescribed.
If we determine that you may be eligible for Valchlor assistance, we will handle the full enrollment process on your behalf. We will work with your healthcare provider to prepare and submit all the documents required for you to enroll. If you are successfully enrolled in the Valchlor patient assistance program, we will also request your Valchlor medication refills on your behalf for up to 1 year. At the end of your enrollment period, we will contact you for updated details and seek to re-enroll you in the program.
Is NiceRx a Valchlor coupon provider?
NiceRx does not provide Valchlor coupons, discount cards or copay cards. We do not offer printable Valchlor manufacturer coupons, Valchlor discounts, rebates, Valchlor savings cards, trial offers, or free samples. We are a service provider that helps eligible individuals access patient assistance programs. Our service cost is $49 a month per medication, so you will likely save more on your Valchlor medication with NiceRx.
Can NiceRx help me get Valchlor cheaper if I have insurance?
NiceRx may be able to help you access Valchlor patient assistance if:
- You have a high copay or coinsurance responsibility for Valchlor
- Your insurance company will not pay for your Valchlor prescription
- You do not have insurance
Complete your enrollment application online to find out more.
How much does Valchlor cost without insurance?
Valchlor prices without insurance will vary by retailer. As a guide, Valchlor topical gel 0.016% will typically cost around $5,150 for 60 grams.
How much does Valchlor cost with insurance?
Your individual healthcare plan will determine the copay of Valchlor with insurance. To find out what you will need to pay, contact your pharmacist or insurance provider. They will be able to calculate your copay with your current insurance.
What is Valchlor?
Valchlor is an FDA (U.S. Food and Drug Administration) approved medication manufactured by Helsinn Therapeutics (U.S.), Inc. Valchlor (mechlorethamine) is also known as nitrogen mustard, an alkylating agent, indicated for the topical treatment of Stage IA and IB mycosis fungoides‐type cutaneous t-cell lymphoma (MF-CTCL in patients who have received prior skin‐directed therapy
What doses of Valchlor are available?
Valchlor is available in gel form, in the following doses: 0.016% w/w of mechlorethamine (equivalent to 0.02% mechlorethamine HCl)
Apply a thin film once daily to affected areas of the skin. Apply to completely dry skin at least 4 hours before or 30 minutes after showering or washing. Let the treated area(s) dry for 5 to 10 minutes before covering with clothing. You may apply moisturizers to the treated area(s) 2 hours before or 2 hours after applying mechlorethamine. Patients and caregivers must thoroughly wash hands after handling or applying Valchlor.
Avoid getting this medication in or around the eyes or eyelids. It can cause pain, burns, blurred vision, and even blindness. Do not apply Valchlor inside the nose or mouth. If you get this medication in the eyes, rinse for at least 15 minutes with plenty of water, normal saline, or an eyewash solution and get medical help right away. Keep Valchlor gel and all medicines out of the reach of children.
Please read the prescribing information and medication guide and always speak with a healthcare professional about any changes to your dose so they can monitor and evaluate your condition.
Valchlor active ingredients
Valchlor contains mechlorethamine as the active ingredient.
Valchlor side effects
The most common side effects of Valchlor in clinical trials include:
- Bacterial skin infection
- Skin ulceration or blistering
- Skin irritation
In rare instances, Valchlor can cause more serious side effects. These can include:
- Mucosal or eye injury may lead to blindness
- Secondary exposure
- Dermatitis – redness, swelling, inflammation, itchiness, blisters, ulceration, and secondary skin infections
- Non‐melanoma skin cancer
- Embryo‐fetal toxicity
Your caregivers will assess the benefits of using Valchlor against your risk of side effects. Patients are encouraged to report negative side effects or adverse reactions of Valchlor to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.
Valchlor drug interactions
Other drugs may interact with Imcivree, including prescription drugs and over-the-counter medicines, vitamins, and herbal products. Tell your health care provider about all of your medicines including any supplements you are taking.
You should not use Valchlor if you:
- Are allergic to the active ingredient mechlorethamine
- Have had an allergic reaction to any of the other ingredients in Valchlor
- Are pregnant or are planning to become pregnant – may harm your unborn baby
- Are breastfeeding or are planning to breastfeed – It is not known if Valchlor passes into your breastmilk
Talk to your doctor before using Valchlor if you:
- Are taking any of the medications that could interact with Valchlor
Valchlor is the trademark brand name for mechlorethamine manufactured by Helsinn Therapeutics (U.S.), Inc. A generic version of mechlorethamine is not available. Generic drugs are generally cheaper than brand-name drugs, but you can still find Valchlor savings through NiceRx.
*Qualifying persons may obtain medications directly from patient assistance programs without any out-of-pocket cost (or for less than $49 per medication). However, our monthly flat rate of just $49 per medication spares you the hassle of tracking the different programs and filling out all the required paperwork for each program. Subject to medication availability.
Enrollees enjoy a full-service solution, as NiceRx assists them and their physicians with the entire process. We prepare all required documents for the physician to sign, help enrollees manage all prescription refills, monitor eligibility criteria, and maintain enrollment.
**If you do not receive medications because you were determined to be ineligible for the prescription assistance by the applicable pharmaceutical companies and you have a letter of denial, we will refund any fees you paid toward medications for which you did not qualify to receive prescription assistance (“Refund”).
To receive a refund, you must send the letter of denial to us by fax to 888-517-7444, or by e-mail to [email protected] within 30 days of your receipt of such letter. The Refund is your sole and exclusive remedy for any fees you may wish to dispute.
The content on this website is intended for information purposes only. It does not constitute medical advice. The information on this website should not be relied upon and is not a substitute for professional medical advice. You should always speak to your doctor regarding the risks and benefits of any treatment.