Your eligible patients with commercial insurance
may pay as little as $0 for each LEQVIO treatment.
No financial information required. Subject to terms
and conditions. Limitations apply.*
Enroll your patient in the co-pay program and manage
claims for reimbursement in one of two ways
Service Center Portal (or Fax)
Access to co-pay and all other services in one
place including benefits verification,
prior
authorization/appeals support, product
acquisition, and billing/coding support
Either complete the Start Form or
enroll your patient
using the
Service Center Portal to access all
services, including co-pay
Receive an explanation of benefits from the health plan
Submit a co-pay claim electronically
or
by fax (download claim forms
here)
OR
Co-pay Portal
Access to co-pay savings, submission for
co-pay claims, and tracking payment status
Enroll your patient in the Co-pay Portal
Receive an explanation of benefits from the health plan
Submit a co-pay claim electronically
or
by fax (download claim forms
here)
Patients can sign up for the co-pay
program directly by visiting
LEQVIO.com or calling us at
833-LEQVIO2 (833-537-8462)
833-LEQVIO2
(833-537-8462)
If uninsured or underinsured patients express financial hardship,
the Service Center can help connect them with the
Novartis Patient Assistance Foundation to determine eligibility.
* Limitations apply. Valid only for those with commercial insurance. The Program may include the Co-pay Card, Payment Card (if applicable), and Rebate. Per treatment maximums and an annual benefit cap apply. For patients covered under the medical benefit, rebate for out-of-pocket costs will be assigned directly to provider, unless patient requests direct reimbursement. Patient is responsible for any costs once limit is reached in a calendar year. Program not valid (i) under Medicare, Medicaid, TRICARE, VA, DoD, or any other federal or state health care program, (ii) where patient is not using insurance coverage at all, (iii) where the patient's insurance plan reimburses for the entire cost of the drug, or (iv) where product is not covered by patient's insurance. The value of this program is exclusively for the benefit of patients and is intended to be credited towards patient out-of-pocket obligations and maximums, including applicable co-payments, coinsurance, and deductibles. Program is not valid where prohibited by law. Patient may not seek reimbursement for the value received from this program from other parties, including any health insurance program or plan, flexible spending account, or health care savings account. Patient is responsible for complying with any applicable limitations and requirements of their health plan related to the use of the Program. Valid only in the United States and Puerto Rico. This Program is not health insurance. Program may not be combined with any third-party rebate, coupon, or offer. Proof of purchase may be required. Novartis reserves the right to rescind, revoke, or amend the Program and discontinue support at any time without notice.
