VALCHLOR® (mechlorethamine) gel is an alkylating drug 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

Prescribing VALCHLOR

1

VALCHLOR is available from a specialty pharmacy

Complete the Patient Enrollment and Prescription Form then fax it to
VALCHLOR Support® at 1-877-251-9475.

Patient Enrollment and Prescription Form English Español

2

will call your patient and provide:

  • Insurance verification and information on financial assistance for eligible patients
  • Resources for disease and product information
  • Prescription management and refill instructions
3

VALCHLOR is shipped directly to your patient:

  • VALCHLOR is supplied through a specialty pharmacy under quality-controlled conditions
  • VALCHLOR Support® provides monthly reminders to your VALCHLOR patients