wcfert.blogg.se - Inflectra copay assistance

The Co-pay Assistance Program may apply to patient out-of-pocket costs incurred for Program Product within 90 days prior to the date patient is enrolled in the Co-pay Assistance Program, subject to annual Co-pay Assistance Program maximum and the applicable Terms and Conditions based on Program Product administration date.Product must originate and be administered to patient in the United States or the Commonwealth of Puerto Rico. Patient must be a resident of the United States or the Commonwealth of Puerto Rico.Patient and health care provider are responsible for reporting receipt of Co-pay Assistance Program benefits to any insurer, health plan, or other third party who pays for or reimburses any part of the medication cost paid for by the Co-pay Assistance Program, as may be required. Patient and health care provider agree not to seek reimbursement for all or any part of the benefit received by the patient through the Co-pay Assistance Program.The EOB must reflect the patient’s out-of-pocket cost for the Program Product and submission of the claim by the patient’s health care provider for the cost of the Program Product. An EOB from patient’s private health insurance must be submitted within 180 days of the date of the EOB for patient to receive co-pay assistance benefit provided, however, that no EOB may be submitted more than 180 days after the expiration date of the Co-pay Assistance Program.The maximum Co-pay Assistance Program benefit per patient, per calendar year (January 1 through December 31), is $20,000. The benefit available under the Co-pay Assistance Program is limited to the amount the patient’s private health insurance company indicates on the Explanation of Benefits ("EOB") that the patient is obligated to pay for the Program Product, less $5, up to an annual maximum. Patient must pay the first $5 of co-pay per administration of Program Product.

Claim for Program Product must be submitted by health care provider to patient’s private health insurance separately from other services and products. It is not valid for any other out-of-pocket costs (for example, office visit charges or medication administration charges) even if such costs are associated with the administration of the Program Product. The benefit available under the Co-pay Assistance Program is valid for the patient’s out-of-pocket cost for the Program Product only.

Patient must have an out-of-pocket cost for the Program Product and be administered the Program Product prior to the expiration date of the Co-pay Assistance Program.

Subject to changes in state law, the Co-pay Assistance Program may become invalid for residents of Massachusetts prior to its expiration date.

The Co-pay Assistance Program is not valid for uninsured patients.

The Co-pay Assistance Program is not valid for patients covered under Medicaid (including Medicaid patients enrolled in a qualified health plan purchased through a health insurance exchange established by a state government or the federal government), Medicare, a Medicare Part D or Medicare Advantage plan (regardless of whether a specific prescription is covered), TRICARE, CHAMPUS, Puerto Rico Government Health Insurance Plan (“Health care Reform”), or any other state or federal medical or pharmaceutical benefit program or pharmaceutical assistance program (collectively, “Government Programs”).

Patient must have private health insurance that provides coverage for the cost of the Program Product under a medical benefit plan.

Patient must be prescribed the Program Product for an FDA-approved indication.

To receive benefits under the Co-pay Assistance Program for RENFLEXIS (“Program Product”), the patient must enroll in the Co-pay Assistance Program and be accepted as eligible.

Terms and Conditions - RENFLEXIS - (Medical Benefit): Both sets of Terms and Conditions for the Co-pay Assistance Program for RENFLEXIS are set forth below. The Organon Co-pay Assistance Program ("Co-pay Assistance Program") for RENFLEXIS consists of two sets of Terms of Conditions, one applicable to RENFLEXIS for which a claim is submitted by a patient’s health care provider (“Medical Benefit”) and the other applicable to RENFLEXIS purchased by a patient at a participating pharmacy (“Pharmacy Benefit”).