Eligible commercially insured patients may lower their out-of-pocket costs to as low as $0.
During participation in the program, assistance provided by Biogen will not exceed an individual annual cap, which is based on certain factors, including but not limited to, insurance coverage, claim details, and/or participation in other insurance plan-sponsored programs. Once this cap is reached, you will be responsible for paying 100% of your total copay amount. By completing this form, you will be screened for eligibility in the AVONEX Copay Program.
Federal and state laws and other factors may prevent or otherwise restrict eligibility. People covered by Medicare, Medicaid, Veterans Affairs (VA), the Department of Defense (DoD), or any other federal plans are not eligible to enroll. You are eligible to enroll in the AVONEX Copay Program for as long as it is offered and you are treated with this Biogen medication, provided that you meet the eligibility criteria.
*TRICARE® is a registered trademark of the Department of Defense; Defense Health Agency. All rights reserved.
By using the AVONEX Copay Program, the patient acknowledges and confirms that, at the time of usage, they are currently eligible and meet the criteria set forth in the terms and conditions described below.
The AVONEX Copay Program is valid ONLY for patients with commercial insurance who have a valid prescription in accordance with FDA-approved Prescribing Information. The patient must have a US prescriber and a US shipping address. The patient must be a US resident or US citizen. If the patient has federally-funded insurance, such as Medicare, Medicaid, VA, TRICARE®*, or DoD insurance coverage, the patient is not eligible for assistance through the Biogen Copay Program for AVONEX. If the patient obtains a federally-funded plan, such as Medicare, Medicaid, VA, TRICARE®, or DoD, at any time during the enrollment period, the patient must notify Biogen immediately, and Biogen may be required to stop copay payments and immediately remove patient from the program.
The AVONEX Copay Program covers only the cost of the drug and does not cover copays related to administration, office visits, or any network penalties levied by patient’s insurance. The assistance provided through the Copay Program will be subject to an annual cap. Once the maximum amount of assistance has been provided, the patient will be responsible for paying 100% of total copay amounts for the remainder of the year after funds are exhausted.
The AVONEX Copay Program is not valid if the costs are eligible to be reimbursed in their entirety by private insurance or other programs.
The AVONEX Copay Program cap will reset every January 1st. These programs are not health insurance or benefit plans. The programs do not obligate the use of a specific product or provider.
The Copay Program is intended to help patients afford AVONEX. Patients may have insurance plans that attempt to increase the amount of patient’s out-of-pocket costs to reflect the availability of support offered by a manufacturer assistance program. In those situations, the program may change its terms including but not limited to removing these patients from the program.
Biogen will not provide copay assistance directly to the patient. All program claims will be paid directly to the patient’s pharmacy upon receipt of appropriate claim submission. The patient’s pharmacy will be responsible for submitting claims directly to the AVONEX Copay Program.
All patients are responsible for appropriately reporting enrollment into the AVONEX Copay Program as required by their insurer. It is the patient’s responsibility to ensure compliance with all terms of their insurance as outlined by their insurance plan.
Eighteen (18) months of inactivity may result in removal from the AVONEX Copay Program.
Biogen reserves the right to modify or discontinue this program with respect to any patient, or in its entirety, at any time. Patient participation does not mean that the patient is entitled to receive assistance indefinitely.
Pharmacist instructions for a patient with an Eligible Third Party: Submit the claim to the primary Third Party Payer first, then submit the balance due to SS&C Health as a Secondary Payer COB [coordination of benefits] as a copay only billing using BIN 019158 with patient responsibility amount and a valid Other Coverage Code, (e.g. 8). The patient's drug assistance provided through the Copay Program will be subject to an annual cap and reimbursement will be received from SS&C Health. Valid Other Coverage Code required. For any questions regarding SS&C Health online processing, please call the Help Desk at 1-844-373-0987.
*TRICARE® is a registered trademark of the Department of Defense; Defense Health Agency. All rights reserved.
AVONEX is a prescription medicine used to treat relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease in adults.
It is not known if AVONEX is safe and effective in children.
Before beginning treatment, you should discuss with your healthcare provider the potential benefits and risks associated with AVONEX.
AVONEX can cause serious side effects. Tell your healthcare provider right away if you have any of the symptoms listed below while taking AVONEX.
If you have any of these mood or behavior problems, your healthcare provider may tell you to stop taking AVONEX.
Get emergency help right away if you have any of these symptoms. Talk to your healthcare provider before taking another dose of AVONEX.
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
You may be able to manage these flu-like symptoms by taking over-the-counter pain and fever reducers. Talk with your healthcare provider about ways to help if you develop flu-like symptoms while taking AVONEX.
These are not all of the possible side effects of AVONEX.
Call your healthcare provider for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Please see full Prescribing Information and Medication Guide.
This information does not take the place of talking with your healthcare provider about your medical condition or your treatment.
AVONEX is a prescription medicine used to treat relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease in adults.