G1 to One Patient Support Program: Cosela

Funded

About

The G1 to One Patient Support Program: Cosela offers significant assistance for eligible patients requiring the drug Cosela. By joining the G1 to One Patient Support Program, patients who are uninsured or underinsured may qualify to receive Cosela at no cost. The program facilitates an easy process for healthcare providers and patients through a comprehensive enrollment form and supports financial assistance for those who meet specific requirements.

Insurance requirements: Underinsured, Uninsured

Enrollment Forms

Enrollment Form

Program Requirements

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: Yes

•Activation Required: No

Program Details

•Eligible uninsured or underinsured patients may be able to receive COSELA at no cost

•HCP and patient should fax completed and signed enrollment form to 8333294121

•Submitting the completed form will initiate a benefits investigation that includes coverage status, prior authorization requirements, and patient outofpocket costs

•HCP will be notified of results

•Call 8334186663 or email Enroll@G1toOne.com for assistance or additional information

Enrollment Forms

Enrollment Form