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 practice
Enroll 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 eligible
Help identify patients who may be eligible for the AVSOLA® Co-Pay Program.
Help patients enroll
Help 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 forms
To submit an Explanation of Benefits (EOB) or other documentation, sign in.
Begin accepting AVSOLA® Co-Pay Card
Swipe 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.

Enroll

I want to join the AVSOLA® Co-Pay Program

Enroll

Sign in

I'm already enrolled

Sign in

Resources

View and download forms for AVSOLA® Co-Pay Program

Continue

The AVSOLA® Co-Pay Program Prepaid MasterCard® is issued by Comerica Bank pursuant to license by MasterCard International Incorporated. No cash or ATM access. MasterCard is a registered trademark of MasterCard International Incorporated. This card can be used only to cover co-payment for eligible prescriptions covered under the program at participating merchant locations where Debit MasterCard is accepted.