Medicare and Patient Assistance
Patients receiving UDENYCA® (pegfilgrastim-cbqv) with no insurance or who are insured with
traditional Medicare fee-for-service (FFS) that demonstrate financial hardship and cannot afford
their cost-sharing obligation may be eligible for patient assistance through the Patient Assistance Program (PAP). Patients with other government insurance, including Medicare
Advantage, Medicare Part D, Fee-for-service Medicaid, Managed Medicaid, Veterans Affairs,
Department of Defense, TRICARE, or any other insurance that is federally or state-funded are not
eligible for Patient Assistance.
UDENYCA® can be provided at no cost to eligible underinsured* patients with financial hardship*
through the Patient Assistance Program (PAP).
Patient Eligibility Criteria (must meet all to qualify)
Be either: (a) uninsured; (b) functionally underinsured*; or (c) traditional Medicare FFS insured
patient(s) that demonstrate financial hardship and cannot afford their cost-sharing obligation
as evidenced by a signed attestation from their provider
Have an adjusted annual household income of ≤ 500% of Federal Poverty Level (FPL)
Complete and sign consent form and, when applicable, provide income documentation
Be under the care of a U.S. licensed provider, and receive UDENYCA® in an established
practice located in the U.S. incident to the prescribing physician’s professional services in the
Be a U.S. resident of any U.S. state
Diagnosis and dosing are consistent with FDA-approved indication for UDENYCA®
Not have any other financial support options
- The patient must receive the drug in an outpatient setting by the physician or physician office
Adjusted annual household income of ≤ 500% of Federal Poverty Level (FPL)
Patient must complete and sign the consent and, when applicable, provide income
Providers: For insured patients I understand that the Coherus Solutions™ program does not
provide free drug in the instance of an administrative error or a coverage restriction such as a
step edit or others deemed as restrictions. For certain products where step edit may not be
medically appropriate, and confirmed by the prescribing physician, the Coherus Solutions™
program may consider enrollment following one level of appeal.Must be enrolled in
Providers requesting more than six (6) PAP fills for the same patient will be required to provide
written attestation on business letterhead reaffirming continued PAP necessity (DX, patient
therapy log, etc.)
* Functionally Underinsured means the patient does not have coverage for UDENYCA®
or any other pegfilgrastim product (biosimilar or reference).
Proactive Alternative Funding Notifications
Coherus SolutionsTM may also be able to help your patients find financial support through charitable foundations. Patient Access Specialist can research alternative coverage options for your patients.
- When funding becomes available, your practice will receive email notifications alerting you to available funds from charitable foundations.
- Must be enrolled in Coherus SolutionsTM
Contact Coherus SolutionsTM for detailed eligibility requirements at 1-844-4-UDENYCA or apply online at Coherus Solutions
Retrospective Patient Assistance
Coherus SolutionsTM may be able to assess patient eligibility for retrospective patient
assistance. Please contact Coherus SolutionsTM 1-844-483-3692 for additional information.
Medicare patients are not eligible for retrospective patient assistance.
If eligible, the Patient Assistance Program only covers the costs of UDENYCA® and does not
cover any administration or office visit costs. Restrictions may apply and not valid where
prohibited by law. Coherus may revise or terminate this program without notice at any time for