EMD Serono and Pfizer provide the CoverOne program, a patient assistance program that offers reimbursement services, copay assistance, and billing and coding resources for patients who are prescribed Bavencio (avelumab), a fully human anti–PD-L1 monoclonal antibody.
Bavencio is indicated for the treatment of patients aged ≥12 years with metastatic Merkel-cell carcinoma, and for patients with locally advanced or metastatic urothelial carcinoma whose disease progressed during or after platinum-containing chemotherapy or within 12 months of neoadjuvant or adjuvant platinum-containing chemotherapy (Table).
CoverOne provides several support services for patients who are prescribed Bavencio. The program provides assistance options for patients with all types of insurance.
Patient Assistance Program
Bavencio may be provided at no charge for uninsured patients who meet certain income and residency eligibility criteria.
CoverOne can assist privately insured patients who meet the program eligibility criteria with copay and coinsurance responsibilities for Bavencio. Patients who enroll in the Co-Pay Assistance program will be responsible for a $10 copay or coinsurance, and may be eligible for Bavencio copay assistance for up to $30,000 annually.
Reimbursement Support Services
The reimbursement support services help patients and physicians understand the specific coverage and reimbursement guidelines for Bavencio, including insurance benefit verification; prior authorization assistance; information on the relevant billing codes; denied or underpaid claims assistance; payer research (non–patient-specific) that covers Medicare, private payers, and state Medicaid; and alternate funding research.
Patient Assistance Program
To determine eligibility, patients and their providers need to complete the patient enrollment form. Patients need to provide gross annual household income (before-tax wages), including Social Security benefits or any other source of household income, and supply income documentation. After submission of the patient enrollment form and any required documents, a CoverOne representative will provide notification of the patient’s eligibility determination.
Co-Pay Assistance Program
CoverOne can assist patients with private insurance copay or coinsurance responsibilities who meet the following program eligibility criteria:
- Must not have any claims covered, paid, or reimbursed (in whole or part) by Medicaid, Medicare, or other federal or state healthcare programs
- Eligible copay expenses must be connected with a separately paid claim for Bavencio administered in an outpatient setting, which is otherwise covered by a private or commercial plan.
Patients enrolled in this program will be responsible for a $10 copay or coinsurance, and may be eligible for Bavencio copay assistance for up to $30,000 annually.
Application & Enrollment
To enroll in CoverOne programs and services, patients and their providers must complete this enrollment form, and fax it to 800-214-7295. This form is required for reimbursement support, patient assistance support, and copay assistance support.