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EMD Serono, Inc.

CoverOne®

EMD Serono, Inc. offers the CoverOne program for patients prescribed Bavencio. CoverOne provides patient access and reimbursement support services to help eligible patients gain appropriate access to Bavencio in the United States. CoverOne recognizes that each patient’s situation is different and is dedicated to helping them one at a time.

For more information, search Bavencio in this Guide, go online, or call 844.826.8371, Monday through Friday, 8:00 AM to 8:00 PM EST.

Oncology Navigation CenterTM (ONC)

EMD Serono, Inc. offers the Oncology Navigation Center for patients prescribed Tepmetko. The ONC is a patient access and reimbursement support program available to help eligible patients gain appropriate access to Tepmetko.

For more information, search Tepmetko in this Guide, go online, or call 1.844.662.3631, Monday through Friday, 8:00 AM to 8:00 PM EST.

 

Oncology-related products: Bavencio® (avelumab) injection, Tepmetko® (tepotinib) tablets

Reimbursement Assistance

CoverOne®

CoverOne will help healthcare providers and patients understand the specific coverage and reimbursement guidelines for Bavencio. Reimbursement support services include:

  • Insurance benefit verification

  • Prior authorization assistance

  • Information on relevant billing codes for Bavencio (HCPCS, CPT, ICD-10-CM, NDC)

  • Denied/underpaid claims assistance

  • Payer research (non-patient specific) for Medicare, private payers, and state Medicaid.

Enroll patients online or fax a completed enrollment form to 1.800.214.7295 to request services.

EMD Serono, Inc. and Pfizer, Inc. do not guarantee coverage and/or reimbursement for Bavencio. Coverage, coding, and reimbursement policies vary significantly by payer, patient, and setting of care. Actual coverage and reimbursement decisions are made by individual payers following the receipt of claims. Patients and healthcare professionals should always verify coverage, coding, and reimbursement guidelines on a payer- and patient-specific basis.

For more information, contact 844.826.8371, Monday through Friday, 8:00 AM to 8:00 PM EST.

NOTE: When Bavencio is used in combination with axitinib, questions related to reimbursement and access for axitinib may be referred to Pfizer Oncology Together™.

Co-Pay Card/Out-Of-Pocket Cost Assistance

CoverOne® Co-Pay Assistance Program

CoverOne provides co-pay assistance for privately insured Bavencio patients with co-pay/coinsurance responsibilities who meet the program eligibility criteria. Enrolled patients may be eligible to pay as little as a $0 co-pay for each treatment for Bavencio, up to a maximum of $30,000 per year. Once the annual co-pay assistance limit is reached, enrolled patients are responsible for paying all co-pays and any balance not covered by CoverOne.

Healthcare professionals may submit an application for co-pay assistance for their privately-insured patients by submitting an enrollment form through the CoverOne Enrollment Portal or by faxing a completed downloadable enrollment form to 1.800.214.7295.

CoverOne is not permitted to offer co-pay assistance to any claims covered, paid, or reimbursed, in whole or in part, by Medicaid, Medicare, or other federal or state healthcare programs.

Enrollment in the co-pay assistance program does not guarantee assistance. Whether an expense is eligible for the program benefit will be determined at the time the benefit is paid. Eligible co-pay expenses must be in connection with a separately paid claim for Bavencio administered in an outpatient setting, which is otherwise covered by a private or commercial insurance plan.

For more information, contact 844.826.8371, Monday through Friday, 8:00 AM to 8:00 PM EST.

NOTE: When Bavencio is used in combination with axitinib, questions related to reimbursement and access for axitinib may be referred to Pfizer Oncology Together™.

Patient Assistance Program

CoverOne® Patient Assistance Program

CoverOne includes a patient assistance program that provides Bavencio at no charge for patients who meet certain income, insurance (i.e., uninsured), and residency eligibility criteria.

To determine patient eligibility, providers should complete enrollment online or fax the downloadable enrollment form to 1.800.214.7295 prior to treatment. Patient assistance is not applied retroactively.

A CoverOne representative will notify the healthcare provider as soon as possible with a patient's eligibility determination. The CoverOne patient assistance program is a philanthropic program for patients in need and is not contingent on any past or future commercial sale.

For more information, contact 844.826.8371, Monday through Friday, 8:00 AM to 8:00 PM EST.

NOTE: When Bavencio is used in combination with axitinib, questions related to reimbursement and access for axitinib may be referred to Pfizer Oncology Together™.

Insurance Coverage-Related Delay Program

ONC Bridge Program

The Oncology Navigation Center has established a bridge program to assist eligible patients in accessing their initial prescription of Tepmetko free of charge if the following criteria are met. Patients must

  • Be a new patient with a prescription for Tepmetko

  • Be diagnosed by their physician with the FDA-approved indication of Tepmetko

  • Be insured (i.e., a commercial insurer or a federal healthcare program)

  • Have experienced a delay in a coverage determination of at least five business days.

To apply, fax a completed enrollment form to 844.501.0062 to verify benefits or request assistance.

For questions, call 1.844.662.3631, Monday through Friday, 8:00 AM to 8:00 PM EST.

Co-Pay Card/Out-Of-Pocket Cost Assistance

ONC Co-Pay Assistance Program

The Oncology Navigation Center (ONC) provides a co-pay assistance program to help privately insured patients who meet the program eligibility criteria with co-pay/coinsurance responsibilities. Enrolled patients may be eligible to pay as little as a $0 co-pay for each prescription of Tepmetko up to a maximum of $15,000 per year.

Government insured patients, including Medicare Part D/Medicare Advantage, and Medicaid beneficiaries, are not eligible for the program.

For enrolled patients, co-pay assistance will be applied when the privately insured pharmacy claim is adjusted.

Privately insured patients may apply for co-pay assistance online or by faxing the enrollment form via fax to 844.501.0062.

For questions, call 1.844.662.3631, Monday through Friday, 8:00 AM to 8:00 PM EST.

Patient Assistance Program

ONC Patient Assistance Program

The Oncology Navigation Center (ONC) includes a patient assistance program that provides Tepmetko at no charge to patients who meet certain insurance (i.e., uninsured), income, and residency eligibility criteria.

To determine patient eligibility, healthcare providers should complete and fax the enrollment form prior to treatment to 844.501.0062.

An access navigator will notify healthcare providers as soon as possible about the patient’s eligibility status. If eligible, the program will ship the free supply of Tepmetko to the patient.

Note: The ONC patient assistance program is a support program for patients in need and is not contingent on any past or future commercial sale of Tepmetko.

For questions, call 1.844.662.3631, Monday through Friday, 8:00 AM to 8:00 PM EST.

Reimbursement Assistance

Oncology Navigation Center™

Oncology Navigation Center (ONC) access navigators are available to help patients and their care teams understand how Tepmetko may be covered under each patient’s insurance/pharmacy benefits. Reimbursement support includes:

  • Patient-specific benefit verification
  • Formulary research for Medicare Part D, private payers, Medicaid
  • Information on relevant billing codes
  • Prior authorization assistance
  • Appeals assistance.

Fax a completed enrollment form to 844.501.0062 to verify benefits or request assistance.

For questions, call 1.844.662.3631, Monday through Friday, 8:00 AM to 8:00 PM EST.