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 and fax a CoverOne Enrollment Form prior to treatment 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.