CO-PAY ASSISTANCE

CoverOne provides co-pay assistance for privately-insured BAVENCIO® (avelumab) 20mg/mL patients with co-pay/co-insurance responsibilities who meet the program eligibility criteria. Limits, terms and conditions apply, see below

  • HCPs may submit an application for co-pay assistance for their privately-insured patients by submitting an enrolment form through the CoverOne Enrollment Portal or by faxing a completed Enrollment Form to 1-800-214-7295.
  • We are not permitted to offer CoverOne Co-pay Assistance to any claims covered, paid or reimbursed, in whole or in part, by Medicaid, Medicare, or other federal or state healthcare programs.
  • Enrollment in the co–pay assistance program does not guarantee assistance. Whether an expense is eligible for the CoverOne Co-Pay Assistance benefit will be determined at the time the benefit is paid. Eligible co-pay expenses must be in connection with a separately paid claim for BAVENCIO® administered in outpatient setting, which is otherwise covered by a private/commercial insurance plan.
  • Enrolled patients may be eligible to pay as little as a $0 co-pay for each treatment for Bavencio, up to a maximum of $30,000 per year.
  • Once the annual co-pay assistance limit is reached, enrolled patients are responsible for paying all co-pays and any balance not covered by CoverOne.
  • CoverOne Address: PO Box 29293, Phoenix, AZ 85038-9293, CoverOne toll-free phone number: 844-8COVER1 (844-826-8371)

When BAVENCIO is used in combination with axitinib, questions related to reimbursement and access for axitinib may be referred to Pfizer Oncology TogetherTM. 
Pfizer Oncology TogetherTM provides personalized support and financial assistance resources to help patients access their prescribed axitinib. To learn more, call 1-877-744-5675 (Monday–Friday 8 AM–8 PM ET) or visit Pfizer Oncology Together.

 

 

CO-PAY PROGRAM TERMS AND CONDITIONS

The patient co-pay assistance program is not contingent on any past or commercial sale of BAVENCIO. The co-pay program does not assist with inpatient hospital claims, or in any bundled payment arrangement where there is no separate patient co-pay for BAVENCIO, and does not assist with healthcare premiums or drug administration services.

By enrolling in the CoverOne co-pay program, you acknowledge that you currently meet the eligibility criteria and will comply with the Terms and Conditions described below:

  1. The CoverOne Co-pay program is offered to eligible BAVENCIO (avelumab) Injection patients who are insured through a private/commercial health plan, and are enrolled in CoverOne.
  2. The offer is not valid for medicines that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare, or other federal or state healthcare programs (including any state prescription drug assistance programs and the Government Health Insurance Plan available in Puerto Rico [formerly known as "La Reforma de Salud"]).
  3. If your insurance status changes, you must notify us immediately.
  4. This offer is not valid for medicines that are eligible to be reimbursed this private insurance plans or other health or pharmacy benefit programs, which reimburse you for the entire cost of your prescription drugs.
  5. CoverOne may provide co-pay assistance to eligible Bavencio patients up to $30,000 per calendar year. Enrolled patients are responsible for all co-pays and any other balances not covered by the CoverOne co-pay assistance program.
  6. You must deduct the value received under this program from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf.
  7. This offer cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified medicine. This offer is not health insurance.
  8. The CoverOne Copay Program Offer is good only in the United States and US Territories. Patient must be a US resident.
  9. The CoverOne Copay-Card is only available at participating medical facilities, or pharmacies.
  10. EMD Serono, Inc. and Pfizer Inc. reserve the right to rescind, revoke, or amend the program without notice at any time.
  11. There are no membership fees associated with this offer.
  12. The Co-Pay Program offer is limited to 1 per person during this offering period and is not transferable.
  13. In order to receive co-pay program assistance after enrollment, the patient or provider must submit an Explanation of Benefits form (EOB). The EOB must include the name of the insurer and plan information, and show that BAVENCIO was administered in an outpatient setting and paid separately. If the EOB indicates that the patient does not meet the eligibility criteria, including the criteria described in paragraphs 1 and 2 of this section, co-pay assistance will not be payable. Claims must be submitted to CoverOne within 180 days of the date of the EOB from your primary insurance company.
  14. Expiration date: 12/31/2024.
  15. The CoverOne Co-Pay Program is not available where prohibited by law. Once enrolled, you will receive a copay program debit card. Please refer to the CoverOne Co-pay Claim Submission Instructions for additional information.
  16. The CoverOne Co-Pay Assistance Program is entirely for the benefit of eligible patients.

©2021 Merck KGaA, Darmstadt, Germany or its affiliates. All rights reserved. EMD Serono is the Healthcare business of Merck KGaA, Darmstadt, Germany, in the U.S. and Canada. BAVENCIO is a registered trademark of Merck KGaA, Darmstadt, Germany or its affiliates.

COOKIE SETTINGS

US-AVE-00859     January 2022

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit http://www.fda.gov/medwatch, or call 1-800-FDA-1088. The health information contained herein is provided for educational purposes only and is not intended to replace discussions with a healthcare provider. All decisions regarding patient care must be made with a healthcare provider, considering the unique characteristics of the patient. The product information provided in this site is intended only for residents of the United States. The products discussed herein may have different product labeling in different countries.

You are about to leave the CoverOne website and are being redirected to a non-CoverOne website. Neither EMD Serono nor Pfizer review or control the content of the following website. This redirection does not constitute an endorsement by EMD Serono or Pfizer of the following organization or any information provided by the organization.

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