Briumvi Copay Assistance Program - Non-covered benefit

Funded

About

The Briumvi Copay Assistance Program - Non-covered benefit offers substantial financial support for patients prescribed Briumvi, a crucial medication. Designed for individuals with private insurance or those uninsured, the program helps cover significant out-of-pocket costs, ensuring affordability for eligible participants. Briumvi Copay Assistance Program aims to make treatment accessible by providing an annual re-enrollment feature for continued financial support.

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

•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

•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

Enrollment Forms

Enrollment Form