Gocovri OnBoard Co-Pay Assistance Program

Funded

About

The Gocovri OnBoard Co-Pay Assistance Program offers significant financial benefits to eligible U.S. or Puerto Rico residents using the drug product Gocovri. With the Gocovri OnBoard Co-Pay Assistance Program, patients can reduce their co-pay to as low as $20, making Gocovri more accessible. This program ensures that only the medication costs are covered, and patients can enjoy these benefits for up to 12 months from enrollment. The Gocovri OnBoard Co-Pay Assistance Program requires a valid prescription and offers support for multiple prescriptions if needed.

Insurance requirements: Commercially insured

Enrollment Forms

Enrollment Form

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

•Eligible patients may have a copay as low as $20

•Program only covers cost of medication, no other treatment costs

•Program expires within 12 months from enrollment

•Patients must have a valid prescription

•If patient dosage requires 2 separate prescriptions per month, program may be applied to both fills

•Login to processing portal: TrialCard, Password: tclogin

•Patient must call at the end of the year to reenroll

•For any assistance and more information patients must call 18444626874

Enrollment Forms

Enrollment Form