Fensolvi TotalSolutions Copay Assistance

Funded

About

The Fensolvi TotalSolutions Copay Assistance program offers financial support for patients prescribed Fensolvi, allowing eligible commercially insured individuals to pay as little as $5 per prescription with a maximum benefit of $10,000 annually. This comprehensive program is a great resource for reducing out-of-pocket costs for Fensolvi, ensuring accessible treatment for those with private insurance coverage.

Insurance requirements: Commercially insured

As low as: $5 per fill

Enrollment Forms

Enrollment Form

Benefits

•$10000 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 pay as little as $5 per prescription

•Maximum benefit of $10,000 per calendar year

•Restrictions or limits may apply

•Completed enrollment form can be faxed to: 14125203442 or emailed to: FensolviTotalSolutionsCopay@connectiverx.com

•Claims must be submitted to the Program within 180 days of the date of the Explanation of Benefits (EOB) from patient's primary insurance company

•For more information patients must call 1888FENSOLVI (18883367658)

Enrollment Forms

Enrollment Form