Saphnelo Co-pay Savings Program

Funded

About

The Saphnelo Co-pay Savings Program offers significant benefits for eligible patients by reducing the costs associated with the drug product, Saphnelo. This program aims to make the drug more affordable by allowing commercially insured patients to pay as little as $0 per administration, with a maximum annual benefit of $16,500. The Saphnelo Co-pay Savings Program helps cover the cost of the drug and its administration, ensuring that patients can access their required treatment with minimal financial burden.

Insurance requirements: Commercially insured, Underinsured

Enrollment Forms

Enrollment Form

Benefits

•$16500 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 commercially insured patients may pay as little as $0 per administration

•Maximum benefit of $16,500 per calendar year

•The SAPHNELO Patient Savings Programs cover the cost of the drug and its administration, but do not cover costs for office visits

•Patients are responsible for any cost associated with the infusion administration above the $150 per infusion administration provided by the program

•Patients who are residents of Massachusetts and Rhode Island are not eligible for infusion administration assistance

•Offer is invalid for claims or transactions more than 365 days from the date of service

•Patient and HCP must complete form, sign and fax all pages to 8665112360

•HCP or Pharmacy may also enroll patients online at: https://www.myaccess360providerportal.com/

•Call 8667274635, Monday – Friday, 8 am – 6 pm ET, for assistance or additional information

•For any questions regarding Change Healthcare online processing, please call the Help Desk at 8002028319

Enrollment Forms

Enrollment Form