Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 2.
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Patient Access Network Foundation (PAN)

This is a copay assistance program

Provided by: Patient Access Network Foundation


TEL: 866-316-7263


FAX: 866-316-7261
Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

Patient Access Network Foundation (PAN) Application: Contact program

 

Medications

  • avelumab injection; iv (Bavencio) Injection; IV
 

Eligibility Requirements   

Insurance Status *See Additional Information section below
Those with Part D Eligible? Determined case by case
Income Between 400-500% of FPL
Diagnosis/Medical Criteria FDA Approved Diagnosis - See Program Website for Details
US Residency Required? Must reside and receive treatment in US
   

Application

Obtaining Call or complete online
Receiving Complete online or by phone
Returning Complete online or by phone
Doctor's Action Will be discussed with patient and Doctor after request is received
Applicant's Action Call for information or inform doctor that he/she is in need
Decision Communicated Patient and Doctor notified in writing
Decision Timeframe Within 48 hours
   

Medication

Amount/Supply Not applicable
Sent To Patient sent card to be used at pharmacy
Delivery Time Once approved; shipped same day
Refill Process Patient presents voucher/card to pharmacy for each refill
Limit None
Re-application New application every 12 months
   

Additional Information

*Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance.

Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly.

Note: All new enrollment is now done electronically or over the phone. Contact program for details.

Updated September 28, 2020


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 2.
 

CoverOne Program

For Healthcare Professionals Only

Provided by: EMD Serono, Inc. and Pfizer, Inc.

CoverOne Patient Enrollment
PO Box 29293
Phoenix, AZ 85038-9293

TEL: 844-826-8371


Languages Spoken:

English, Others By Translation Service

Program Website

 

Program Applications and Forms

CoverOne Patient Enrollment Form

CoverOne (Oncology Together) Patient Enrollment Form in combination with INLYTA

 

Medications

  • avelumab injection; iv (Bavencio) Injection; IV
 

Eligibility Requirements   

Insurance Status Must have no prescription coverage for needed medication
Those with Part D Eligible? Contact program for details.
Income Not disclosed
Diagnosis/Medical Criteria Medically Necessary as determined by a Doctor
US Residency Required? Must be a US resident
   

Application

Obtaining Call or download
Receiving Faxed or downloaded from website
Returning Fax
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Patient and Doctor are notified
Decision Timeframe Within 1-2 business days
   

Medication

Amount/Supply Contact the program for more details.
Sent To Doctor's office or specific site
Delivery Time Not specified
Refill Process Contact program for details.
Limit Contact the program for details
Re-application New application yearly
   

Additional Information

Resources for HEALTHCARE PROFESSIONALS ONLY.

Co-payment assistance, reimbursement support, and patient assistance programs are available for eligible patients.

Updated August 24, 2020