Byooviz Administration Copay Program

Funded

About

The Byooviz Administration Copay Program offers significant financial assistance for patients prescribed Byooviz. Eligible patients can reduce their copay costs for drug administration by up to $1,000 annually. The Byooviz Administration Copay Program is designed specifically for commercially insured patients to help alleviate financial burdens associated with medication administration.

Insurance requirements: Commercially insured

Enrollment Forms

Enrollment Form

Benefits

•$1000 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

•Eligible commercially insured patients may be eligible to pay lower administration copay costs under this program, up to the $1,000 maximum benefit per calendar year

•The BYOOVIZ Administration Copay Program maximum benefit will reset every January 1st

•HCP must enroll patient in Biogen Biosimilar Support Services prior to applying for copay assistance

•Completed BBSS enrollment form can be faxed to 2406968830; HCP can also enroll patient online at the HCP Portal: https://biogenbiosimilarsupportservices.com/

•After HCP has enrolled patient in the Biogen Biosimilar Support Services, they must also fax the completed Copay Screening Form to 2406968830. Form can be downloaded here: https://www.biogencdn.com/us/biosimilars/byo/2023/byoovizcopayform.pdf)

•The patient’s insurance will be billed first and must pay before copay assistance will be applicable

•Call 8774228360, Monday through Friday, 8:30 am – 8:00 pm ET, for assistance or additional information

•** The Drug Copay Program and Administration Copay Program are different programs with unique eligibility for each; patients must enroll separately as needed

Enrollment Forms

Enrollment Form