•Eligible commercially insured may receive financial assistance
•Apellis will pay the patients eligible copay and/or coinsurance costs up to the program maximum, but that any costs over the program maximum or those that are not eligible for payment under the SYFOVRE
•Copay Program is the patients responsibility
•HCP can enroll electronically using the ApellisAssist Portal at https://apellisassistga.com/login or via fax using the ApellisAssist Enrollment Form that can be
•downloaded: https://syfovreecp.com/wordpress/wpcontent/themes/apellis/pdf/apellisassist_enrollment_form.pdf
•For more information, call ApellisAssist at 18882735547 (1888APELLIS) from 8 AM8 PM ET, Monday–Friday
•Up to a maximum of $25,000 in assistance per calendar year toward an eligible patient’s drug and administration outofpocket copayment and/or coinsurance for SYFOVRE treatments
•Must be enrolled in ApellisAssist to be eligible for CoPay program
•Eligible patients may pay as little as $0 for each SYFOVRE treatment up to the program’s annual assistance limit
•Patients would be responsible for additional outofpocket costs that exceed the limit or are for costs that are not directly related to the cost of SYFOVRE and its administration
•Requests for reimbursement must be submitted within 180 days of date of service