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Registration is simple.
  • Step 1
    Once your physician has prescribed you one of the drugs listed in the VICTORY® Program, you can enrol by phone or fax.
  • Step 2
    You can self-enrol in the VICTORY® Program:
    a) By Fax
    1. Download the enrolment form and fill it out.
    2. Fax the completed form to 1‑833‑884‑5608.
    3. Complete the VICTORY® checklist so you can be prepared when a VICTORY® Program Reimbursement Specialist calls you within one business day of your contacting VICTORY®.
    Download enrolment form here.
    You will need to consult your doctor to find out what type of medication has been prescribed to you before completing the form.
    Or
    b) By Phone
    1. Complete the VICTORY® checklist.
    2. Call 1‑888‑706‑4717 to speak to a VICTORY® Program Reimbursement Specialist.
    To prepare yourself for your call with a VICTORY® Program Reimbursement Specialist, the online checklist identifies some of the information that you will be required to provide.
  • Step 3
    A VICTORY® Program Reimbursement Specialist will contact you within one business day and will help you navigate your coverage options with public and/or private insurance coverage.
  • Step 4
    You fill your prescription.
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Patient enrolment form

Use this form if you have been prescribed one of these oncology or hematology drugs: Aranesp®, BLINCYTO®, KANJINTI®, KYPROLIS®, LUMAKRAS®, MVASI®, Neulasta®, NEUPOGEN®, Nplate®, Vectibix®, or XGEVA®.
If you have been prescribed IMDELLTRATM, please contact a sales representative or the VICTORY® Program to request an enrolment form.
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Checklist

This checklist is for personal use only and is not an online enrolment. Please call or fax to enrol.

Download Checklist icon-pdf Online Checklist

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Access VICTORY®

Once your physician has prescribed you one
of the drugs listed in the VICTORY® Program,
you can enrol in one of two easy ways:

telephonetelephone

By phone:
Call a VICTORY® Program
Reimbursement Specialist
at 1‑888‑706‑4717

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By fax:
Download and complete the online
enrolment form and fax it to
1‑833‑884‑5608