Patient Enrolment Form for the VICTORY® Program Services

Instructions

How it works?

The VICTORY® Program is sponsored by Amgen Canada and administered by a third-party patient support company, consisting of patient-focused access specialists. VICTORY® Program Reimbursement Specialists will help determine if a patient has a private or public drug plan, and whether they are eligible to receive support from Amgen Canada. Once eligibility has been confirmed, patients will receive their medication.

How to enrol?

Once your physician has prescribed you Vectibix® (panitumumab) or Kyprolis® (carfilzomib), you can enrol by filling out this form. Upon completion, VICTORY® will reach out to you to complete the enrolment.

Need help?

The VICTORY® Program support line (1-888-706-4717) provides you and your caregiver access to dedicated support personnel who are knowledgeable about Amgen Canada oncology- and hematology-related medications as well as the reimbursement process.

Hours of operation are as follows:
Open Monday to Friday:

  • Newfoundland Standard Time: 9:30 a.m. to 9:30 p.m.
  • Atlantic Standard Time: 9:00 a.m. to 9:00 p.m.
  • Eastern Standard Time: 8:00 a.m. to 8:00 p.m.
  • Central Standard Time: 7:00 a.m. to 7:00 p.m.
  • Mountain Standard Time: 6:00 a.m. to 6:00 p.m.
  • Pacific Standard Time: 5:00 a.m. to 5:00 p.m.

Choose your VICTORY® Program service:

Select the brand you’ve been prescribed: