Rolvedon ACCESS4Me Bridge Program
Funded
About
The Rolvedon ACCESS4Me Bridge Program offers a valuable opportunity for patients to access the drug Rolvedon, assisting those who experience insurance-related access delays. The program ensures new patients receive one free dose of Rolvedon if they meet the eligibility criteria, such as having commercial insurance and enrolling in ACCESS4Me. This initiative supports patient access to Rolvedon, specifically for those facing prior authorization challenges.
Insurance requirements: Commercially insured
Enrollment Forms
Enrollment Form
Benefits
•1 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: No
•Needs Based: No
•Activation Required: No
Program Details
•*** THIS PROGRAM IS ONLY FOR ROLVEDON ADMINISTERED IN AN INOFFICE SETTING***
•Commercially insured patients can receive one free dose of Rolvedon free of charge for patients that are experiencing a lapse or delay in coverage OR waiting for approval from their insurance provider
•Patient must be new to Rolvedon
•Patient must be enrolled in ACCESS4Me and patient consent is required
•HCP should fax completed enrollment form to 8332817416 or submit electronic enrollment form at HCP portal (https://www.access4meportal.com/)
•Enrollment form must be received and approved prior to the date of injection
•For assistance or additional information, call 8665822737, Monday Friday, 8:00 AM to 8:00 PM (ET)
Enrollment Forms
Enrollment Form