Margenza Co-pay Assistance Program

Funded
About
The Margenza Co-pay Assistance Program offers substantial financial support to eligible patients by covering costs associated with Margenza medication. Beneficiaries of the Margenza Co-pay Assistance Program can receive assistance with co-pays and coinsurance up to $26,000 annually, ensuring accessible and affordable treatment options for Margenza users.
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
•The MARGENZA Copay Program will pay for the entirety of the commercial patient’s remaining cost share, including coinsurance and copays for MARGENZA medicine up to a maximum of $26,000 during a 12month period
•Program payments are limited to the copay or coinsurance costs for MARGENZA medicine only
•Costs associated with healthcare provider administration, other medications, treatments or therapies, bloodwork, transportation or any other costs associated with a patient’s hospital stay or treatment are not covered
•To receive payments under the program, the patient or healthcare provider must submit a completed claim (CMS 1500 or UB04) and an Explanation of Payment (EOP) form
•Submitted form must include the name of the insurer and plan, and show that MARGENZA was the medication that was administered to the patient
•For patients enrolled into the MARGENZA Copay Program, the form requesting payment must be submitted within 180 days of the infusion service/administration date to receive program benefits
•Completed enrollment form can be faxed to 18442565226
•Prescriber must manually sign and date the form
•Enrollment in the program lasts for one year from the date of approval
•Patients are eligible for savings for up to 12 months of therapy, provided they continue to meet program terms and conditions
•If you have any questions, please call MARGENZA Access Support at 1844MEDMGNX (18446336469), MondayFriday 9 AM to 7 PM ET