Chiesi Total Care Patient Assistance Program: Revcovi

Funded

About

The Chiesi Total Care Patient Assistance Program: Revcovi provides eligible patients with access to Revcovi at no cost, contingent upon meeting specific eligibility and financial requirements. This program is a significant benefit for uninsured or underinsured patients who lack coverage for their medication, and it ensures continued support through an annual renewal process. Designed for those prescribed a US FDA-approved indication for Revcovi, the Chiesi Total Care program requires proof of income for financial eligibility and offers additional support through direct contact with their team.

Insurance requirements: Underinsured, Uninsured

Enrollment Forms

Enrollment Form

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: Yes

•Activation Required: No

Program Details

•Patients who meet the financial requirements of the Chiesi Total Care Patient Assistance Program may be eligible to receive Revcovi at no cost

•HCP should fax completed enrollment form to Chiesi Total Care at 18662727079

•Proof of income is required to determine financial eligibility. Proof of income may include W2 form(s), paycheck stubs, and/or prior year tax returns

•For assistance or additional information, call 8662727078, Monday to Friday, 7:00 AM – 6:00 PM (Central Time)

Enrollment Forms

Enrollment Form