To enroll in the Coherus COMPELTE™ Co-Pay Assistance Program, please answer the following questions:
To enroll in the Coherus COMPLETE™ Co-Pay Assistance Program, you must agree to the following statements:
Program Eligibility Terms and Conditions Patient must be prescribed UDENYCA® (pegfilgrastimcbqv) for a medically appropriate use. Must have commercial health insurance that covers the medication costs of UDENYCA®. Patients are not eligible if prescriptions are paid, in whole or in part, by any federal or state-funded programs, including but not limited to Medicare (including Part D, even in the coverage gap) or Medicaid, Medigap, VA, DoD, or TRICARE, or indemnity health insurance plans that do not cover prescription drugs, or HMO insurance plans that reimburse the patient for the entire cost of his or her prescription drugs, or where prohibited by law. The Coherus COMPLETE™ Co-Pay Assistance Program covers ONLY the out-of-pocket cost of UDENYCA® and does not cover any administrative or office visit costs.