ADvantage Ig Patient Support Program: Asceniv

Funded

About

The ADvantage Ig Patient Support Program: Asceniv offers critical financial assistance for patients using the drug product Asceniv. This program provides significant benefits including coverage of up to $15,000 in out-of-pocket costs per calendar year for eligible users of Asceniv. Patients with private commercial insurance may find relief through the program's cost-sharing support, including deductible, copay, or coinsurance coverage specifically for Asceniv.

Insurance requirements: Commercially insured

As low as: $75 per fill

Enrollment Forms

Enrollment Form

Benefits

•$15000 annual maximum benefit

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: No

•Activation Required: No

Program Details

•Program covers up to $15,000 of outofpocket costs per calendar year for eligible patients, after the patient has paid the first $75 of their required ASCENIV deductible, copay or coinsurance and administration amount

•The program does not cover office/facility copays not directly associated with ASCENIV treatment or any other costs excluded by the program guidelines

•Proof required for receiving payment for outofpocket drug costs must be a valid Explanation of Benefits(EOB) or specialty pharmacy invoice, which must be submitted within 120 days after each treatment

•Prescriber must fill out and fax the enrollment form back to ADvantage Ig Patient Support Program at (833) 2160441

•Call (833) 2362246 Monday through Friday, 9:00 am – 6:00 pm Eastern Time for more information

•The Program does not cover office/facility copays not directly associated with ASCENIV treatment or any other costs excluded by the Program guidelines not specifically mentioned

Enrollment Forms

Enrollment Form