IMPORTANT UPDATE:

For 2022, we are implementing an automatic re-enrollment process which will automatically extend any patient with activity in 2021 through 2022. This means there is no action required to re-enroll a patient at this time. Patients may continue to utilize their copay benefits and you may submit explanation of benefits (EOBs) as normal.

Eligibility Criteria: Open to patients with an AVSOLA® prescription and commercial insurance for AVSOLA®. Patients may not seek reimbursement for value received from the AVSOLA® Co-pay Program from any third-party payers, including a flexible spending account or healthcare savings account. This program is not open to uninsured patients or patients receiving prescription reimbursement under any federal, state, or government-funded healthcare program, such as Medicare, Medicare Advantage, Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), the Department of Defense (DoD), or TRICARE, or where prohibited by law. If at any time patients begin receiving prescription drug coverage under any such federal, state, or government-funded healthcare program, patients will no longer be able to use this card and you must call the AVSOLA® Co-pay Program at 1-866-264-2778 (9:00 am-8:00 pm ET, Monday-Friday) to stop participation. Restrictions may apply. Amgen reserves the right to revise or terminate this program, in whole or in part, without any notice at any time. This is not health insurance. Program invalid where otherwise prohibited by law.

Program Details: The AVSOLA® Co-pay Program provides financial support for eligible commercially insured patients. The program does not provide support for supplies, procedures, or any physician-related services associated with AVSOLA®. For eligible patients, the program covers the amount of OOP cost for AVSOLA® that exceeds $25 for each dose, up to a maximum benefit of $8,000 per patient, per calendar year. Patient is responsible for costs above this amount. Patient card is reset every January 1. Patients need to re-verify their eligibility on a yearly basis.
Prescribing Information    Medication Guide
Patients
Healthcare Providers

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Fill out the form below and click "submit" when you finish. When your enrollment is complete, call 866-264-2778 to submit your merchant ID and register the credit card terminal you will be using to process AVSOLA® Co-Pay Cards. All fields are required.

Office enrollment

Have questions about this form? Call the AVSOLA® Co-Pay Program at 866-264-2778 for assistance.

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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.