Omvoh Savings Program - Covered benefit

Coverage RequiredFunded

About

The Omvoh Savings Program - Covered benefit offers substantial savings on the drug Omvoh for eligible patients. The program is designed to assist those with private insurance, providing significant cost reduction on both medical and pharmacy claims, ensuring affordable access to Omvoh for patients who meet the program criteria.

Insurance requirements: Commercially insured

As low as: $5 per fill

Enrollment Forms

Enrollment Form

Benefits

•$9200 annual maximum benefit

•14 maximum fills per year

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: Yes

•Needs Based: No

•Activation Required: Yes

Program Details

•* For patients with commercial insurance with coverage for Omvoh:

•Program savings for claims covered under the medical and/or pharmacy portion of medical insurance for Omvoh are limited up to 3 infusions over total lifetime of the Program and up to 14 injection fills per calendar year, subject to a combined (injection and infusion) maximum monthly savings of wholesale acquisition cost plus usual and customary fees and separate maximum annual savings of $9,200 for each calendar year

•To receive Program savings for the $5 Program, HCP must submit a claim for coverage to patient's medical insurance provider

•For enrolled patients with coverage for Omvoh, the Program may provide support for infusions with a date of service that falls within 120 days prior to the date the enrollment form is received by the Program

Enrollment Forms

Enrollment Form