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.

NOTE: The CoverOne patient assistance program is a philanthropic program for patients in need, and is not contingent on any past or future commercial sale.

©2024 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, TEPMETKO and CoverOne  are registered trademarks of Merck KGaA, Darmstadt, Germany or its affiliates.

COOKIE SETTINGS

US-MULO-00096     06/24

©2024 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, TEPMETKO and CoverOne  are registered trademarks of Merck KGaA, Darmstadt, Germany or its affiliates.

COOKIE SETTINGS

US-MULO-00096     06/24

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.

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