Alexion OneSource CoPay Program: Koselugo

Funded

About

The Alexion OneSource CoPay Program: Koselugo provides financial assistance to eligible patients covering some out-of-pocket costs for the medication Koselugo. This comprehensive support program assists U.S. residents who are commercially insured, ensuring that the costs of Koselugo are manageable for those who qualify. By enrolling in the Alexion OneSource CoPay Program: Koselugo, patients can benefit from an easy enrollment process and continued coverage as long as eligibility criteria are met.

Insurance requirements: Commercially insured

Enrollment Forms

Enrollment Form

Benefits

•$26000 annual maximum benefit

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 be able to receive financial assistance to help cover some outofpocket costs

•Patient may enroll online or by downloading and submitting an enrollment form

•PDF enrollment form is located here: https://alexiononesource.com/kos//media/9ee5d3b6851444ecabf35b3c0a16ab9c.ashx

•Completed enrollment form can be faxed to OneSource at 18004205150 or emailed to OneSource@alexion.com

•Patients who continue to meet the eligibility requirements will be automatically enrolled in the program annually

•For questions, call 1.888.765.4747 8:30 am to 8 pm ET MondayFriday

Enrollment Forms

Enrollment Form