PATIENT ASSISTANCE PROGRAM
CoverOne includes a patient assistance program that provides BAVENCIO® (avelumab) 20mg/mL at no charge for patients who meet certain income, insurance (i.e. uninsured), and residency eligibility criteria.
- To determine eligibility, providers should complete a CoverOne Enrollment Form on the CoverOne Enrollment Portal prior to treatment or fax a form to 1-800-214-7295. Patient assistance is not applied retroactively.
- A CoverOne representative will notify you as soon as possible with the patient's eligibility determination.
Please include one of the following income documents if applying for the Patient Assistance Program: Most recent Federal or State Tax Return, or W2. If tax return or W2 are not available, please provide the following documentation: Most recent 2 months of Paycheck Stubs, Last 2 months Bank Statements showing income deposits, Social Security Statements, Unemployment Check or Statement.
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.