Help your eligible commercially insured patients cover their out-of-pocket medication costs for AVSOLA® through the AVSOLA® Co-Pay Program
When your office is enrolled in the AVSOLA® Co-Pay Program, you can help your eligible patients enroll as well. Participating patients can get help lowering out-of-pocket costs for each infusion of AVSOLA®, download or submit important forms and manage annual re-enrollment on the AVSOLA® Co-Pay website.
Enroll your practiceEnroll via the link below, then call 866-264-2778 to register the credit card terminal that will be used to process the AVSOLA® Co-Pay Card.
Help identify who may be eligibleHelp identify patients who may be eligible for the AVSOLA® Co-Pay Program.
Help patients enrollHelp your eligible patients with their enrollment in the AVSOLA® Co-Pay Program, including the Patient Authorization Form. Remember that patients need to enroll and agree to the Patient Authorization themselves. Patient Authorization Forms can be downloaded here or obtained by calling 866-264-2778 and faxed to 866-406-6155 when completed. Your patient's AVSOLA® Co-Pay Card will then be activated.
Submit formsTo submit an Explanation of Benefits (EOB) or other documentation, sign in.
Begin accepting AVSOLA® Co-Pay CardSwipe or insert the card at each visit for the appropriate deductible, co-insurance or co-payment for one infusion of AVSOLA®*
*The AVSOLA® Co-Pay Program does not cover any other costs related to office visits or administration of AVSOLA®. Other restrictions may apply.