EMD Serono CoverOne Support Services

EMD Serono and Pfizer provide the CoverOne support services, a set of patient assistance programs that offer reimbursement services, copay assistance, and billing and coding resources for patients who are prescribed Bavencio (avelumab), a fully human PD-L1 monoclonal antibody. See the Table for indications and program information.

In addition, the EMD Serono Oncology Navigation Center (ONC) is a patient access and reimbursement support program available to eligible patients who are prescribed Tepmetko (tepotinib). See the Table for indications and program information.

CoverOne Services

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; assistance with denied or underpaid claims; and payer research (not patient-specific) that covers Medicare, state Medicaid, private payers, and alternate funding research.

Patient Assistance Program

Bavencio may be provided at no charge for uninsured patients who meet certain income and residency eligibility criteria. To determine eligibility, providers should complete a CoverOne enrollment form prior to treatment or fax a completed form to 800-214-7295. Patient assistance is not applied retroactively. Patients need to provide their most recent federal or state tax return, W-2, or other required 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

This program can assist patients with private insurance copay or coinsurance responsibilities who meet program eligibility criteria, which include:

• Claims must not be covered, paid, or reimbursed (in whole or part) by Medicare, Medicaid, 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.

Privately insured patients who enroll in the Co-Pay Assistance Program may be eligible for a $0 copay for each treatment for Bavencio, up to a maximum of $30,000 annually.

Click here for additional eligibility criteria, limits, terms, and conditions.

Eligibility, Application, and Enrollment

To determine eligibility and enroll in CoverOne programs and services, providers and their patients must complete an enrollment form. Forms for Bavencio used as a single agent or for its use in combination with Inlyta (axitinib) are available at CoverOne.com. When Bavencio is used in combination with axitinib, questions related to reimbursement and access for axitinib may be referred to Pfizer Oncology Together, which provides personalized support and financial assistance resources to help patients access their prescribed axitinib. Click here to learn more, or call 877-744-5675 (Monday-Friday 8 am-8 pm ET).

Oncology Navigation Center

The EMD Serono ONC is available to help eligible patients gain appropriate access to Tepmetko in the United States. Access navigators help patients through financial and patient support programs.

Reimbursement Support Services

Reimbursement support includes help for Tepmetko patients with: patient-specific benefit verification; formulary research for Medicare Part D, Medicaid, and private prescription payers; information on relevant billing codes; prior authorization assistance; and appeals assistance.

Co-Pay Assistance Program

Tepmetko patients who are privately insured and meet the program eligibility criteria may be helped with copay or coinsurance responsibilities. Government-insured patients, including Medicare Part D/Medicare Advantage and Medicaid beneficiaries, are not eligible for the ONC Co-Pay Assistance Program. Enrolled patients may be eligible to pay as little as a $0 copay for each prescription of Tepmetko up to a maximum of $15,000 per year. Additional terms and conditions may apply.

Patient Assistance Program

The ONC includes a Patient Assistance Program (PAP) that provides Tepmetko at no charge to patients who are uninsured and who meet income and residency eligibility criteria. To determine patient eligibility, providers should complete and fax the ONC Enrollment Form prior to treatment to 844-501-0062. If the patient is eligible, the ONC PAP will ship the free supply of Tepmetko to the patient. The ONC PAP is a support program for patients in need and is not contingent on any past or future commercial sale of Tepmetko.

Bridge Program

ONC has established a Bridge Program to assist eligible patients in accessing their initial prescription of Tepmetko free of charge if the patient’s insurer has not provided a coverage determination for at least 5 business days. This program is limited to new patients with an on-label diagnosis and a prescription for Tepmetko who have either private or government insurance.

The enrollment form for these ONC programs is available at OncNavigationCenter.com.

TABLE EMD Serono Oncology Drugs