Ask your HCP to give you access to the medicine you need
THE ACCORDCARES™ Co-Pay and Patient Assistance Programs
AccordCares offers key support and resources to your patients who may require financial assistance with their treatment.
Patients must meet eligibility requirements to participate in Co-Pay Assistance and Patient Assistance Programs.
Reduce Out-Of-Pocket Expenses
For patients with commercial insurance, the AccordCares Co-Pay Program can be used to reduce the amount of an eligible patient’s out-of-pocket expenses for CAMCEVI®.
Maximum benefit of $10,000 per calendar year for out-of-pocket expenses for CAMCEVI including co-pays or coinsurances.
Assist Your Uninsured Patients
The AccordCares Patient Assistance Program is available to patients without insurance, or for those whose insurance does not cover their medicine. To qualify, patient must meet certain income and other eligibility requirements.
This program is not valid for patients who are enrolled in a state or federally funded insurance program, including but not limited to Medicare, Medicaid, TRICARE, Veterans Affairs health care, a state prescription drug assistance program, or the Government Health Insurance Plan available in Puerto Rico (formerly known as “La Reforma de Salud”).
Program offer is not valid for cash-paying patients and the patients are responsible for any out-of-pocket costs for CAMCEVI that exceed the annual maximum.
The program does not cover or provide support for supplies, procedures, or any physician-related service associated with CAMCEVI.
To be eligible, the patient must have private insurance with coverage of CAMCEVI.
This offer is not valid when the entire cost of their prescription drug is eligible to be reimbursed by their private insurance plans or other private health or pharmacy benefit programs.
The patient must deduct the value of this assistance from any reimbursement request submitted to their private insurance plan, either directly by the patient or on their behalf.
The patient is responsible for reporting use of the program to any private insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the program, as may be required.
The patient should not use the program if their insurer or health plan prohibits use of manufacturer co-pay assistance programs.
The patient must be 18 years of age or older to be eligible for this Co-Pay Program.This program is not considered health insurance.
This program is not valid where prohibited by law. This program cannot be combined with any other savings, free trial, or similar offer for the specified prescription. Valid prescription is required.
Accord BioPharma reserves the right to rescind, revoke or amend this program without notice. This offer is not conditioned on any past, present, or future purchase, including refills. The program terms and offer will expire at the end of each calendar year.
AccordCares may ask for proof of income at any time for the purpose of audit/verification. If requested, the patient agrees to provide proof of income within 30 days of the request. Continuation in the program is conditioned upon timely verification of income.
In addition, the patient agrees to notify AccordCares promptly if their insurance situation changes.
The patient also agrees that Accord BioPharma may verify their eligibility for the AccordCares Program, and the patient understands that such verification may include contacting them or their healthcare provider for additional information and/or reviewing additional financial, insurance, and medical information.
The patient authorizes Accord BioPharma to use their demographic information to access reports on their individual credit history from consumer reporting agencies for the purposes of determining their income eligibility. The patient understands that, upon request, Accord BioPharma will tell them whether an individual consumer report was requested and the name and address of the agency that furnished it. The patient further understands and authorizes Accord BioPharma to use any consumer reports about them and information collected from them, along with other information they obtain from public and other sources, to estimate their income in conjunction with the AccordCares Patient Assistance Program eligibility determination process.
If the patient completed Section 3, they confirm their agreement with the conditions set forth in Section 3 and certify that the information they have set forth in Section 3, including the number of people in their household and their household income, are true and accurate to the best of their knowledge.
The patient further certifies that they will not seek reimbursement or credit for this prescription requested under the AccordCares Patient Assistance Program from any insurer, health plan, or government program, and if they are a member of a Medicare Part D plan, they will not seek to have this prescription, or any cost associated with it, counted as part of their out-of-pocket cost for prescription drugs.
The patient understands that any drugs provided under the AccordCares Patient Assistance Program shall not be sold, traded, bartered, or transferred.
The patient understands they must be a permanent resident of the U.S. or U.S. Territory (including Guam, Puerto Rico, and the Virgin Islands).
The patient understands that any program assistance provided by AccordCares will terminate if the program becomes aware of any fraud or if this medication is no longer prescribed for them.
The patient certifies that they cannot afford this medication.
The patient understands that completing the application does not ensure that they will qualify for this program. In order to qualify for the program, they must live in the United States, or a U.S. territory and they are being treated by a U.S. licensed doctor.
Accord BioPharma reserves the right to rescind, revoke or amend this program without notice.