Briumvi Copay Assistance Program

Funded
About
The Briumvi Copay Assistance Program provides an exceptional opportunity for patients using the drug Briumvi. This program ensures that eligible commercially insured patients may pay as little as $0 for Briumvi treatments, up to an annual maximum of $20,000, making it a highly beneficial option for individuals seeking support with their medical expenses. The Briumvi Copay Assistance Program is designed to alleviate financial barriers and enhance accessibility to essential medication for those who qualify.
Insurance requirements: Commercially insured
Enrollment Forms
Enrollment Form
Benefits
•$20000 annual maximum benefit
Program Requirements
•Valid only for residents in the US and Puerto Rico
•Must be 18 years of age or older
•Enrollment Required: Yes
•Coverage Required: No
•Needs Based: No
•Activation Required: No
Program Details
•Eligible commercially insured patients may pay as little as $0 copay per BRIUMVI treatment up to the annual maximum $20,000
•Patients outofpocket costs up to $550 for the 150mg starting dose then up to $350 per infusion every infusion thereafter; patients are responsible for any costs that exceed the program’s maximum benefits
•The product benefit is only valid for patients who have commercial prescription drug insurance coverage
•The administration benefit is only valid for patients with commercial (private) insurance coverage or where the patient does not have insurance coverage at all. Administration benefit eligibility includes patients who are uninsured/underinsured or who are not using their Medicare A benefit
•The Program may apply retroactively to outofpocket expenses that occurred within 180 days prior to the date of the enrollment
•Claims must be submitted within 365 days from the EOB or dispense date unless otherwise indicated
•HCP must sign and complete form and fax to 18776392525, or HCP may also enroll patients online at: https://www.briumvicopayportal.com/hcp/login
•For questions call 1833BRIUMVI (18332748684) to speak with a BRIUMVI Patient Support Case Manager. Case Managers are available Monday through Friday, 8am to 8pm EST