Fotivda Insurance Coverage Support

Funded

About

The Fotivda Insurance Coverage Support program offers significant benefits to patients requiring Fotivda, particularly during insurance verification delays or coverage interruptions. Designed to support continued access to Fotivda, the program includes a Quick Start and Bridge Program, ensuring patients can maintain their treatment regimen effectively.

Insurance requirements: Commercially insured, Underinsured

Enrollment Forms

Enrollment Form

Program Requirements

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: No

•Activation Required: No

Program Details

•Quick Start Program Provides free FOTIVDA to eligible patients who experience a payer decision delay of 5 business days or more

•Bridge Program Provides free FOTIVDA to eligible patients who experience coverage interruptions while already on treatment

•HCP and patient must complete the enrollment form and fax to 8889202830

•For more information, call 8333684832 MondayFriday (8 am to 8 pm ET)

Enrollment Forms

Enrollment Form