Bavencio

Indicated For

urothelial carcinoma maintenance, Merkel cell carcinoma

About This Medication

# CoverOne Patient Assistance Program Patient Guide: How to Get Bavencio (avelumab) at Low or No Cost Bavencio (avelumab) is an immunotherapy drug used to treat certain advanced cancers, such as Merkel cell carcinoma and urothelial carcinoma. The **CoverOne Patient Assistance Program**, offered through Pfizer, provides **Bavencio at no cost** to eligible uninsured patients who meet income and other criteria[1][2][3]. ## About Bavencio (avelumab) **Bavencio** is a prescription immunotherapy medication given by intravenous (IV) infusion. It works by helping your immune system recognize and attack cancer cells. It's FDA-approved for adults with: - Metastatic Merkel cell carcinoma (MCC) - Locally advanced or metastatic urothelial carcinoma (after platinum chemotherapy) - And other specific cancers, as determined by your doctor[2][3]. Treatment typically involves infusions every 2 weeks at a cancer center or infusion clinic. Your oncologist will decide if it's right for you based on your diagnosis, prior treatments, and health status. Common side effects include fatigue, muscle pain, nausea, rash, and infusion reactions—discuss risks with your doctor[3]. ## Who Qualifies for the Program? The program is for **uninsured patients** (no private insurance or government coverage like Medicare/Medicaid) who live in the US or Puerto Rico and meet income guidelines[1][2][6]. You must have a valid prescription from a US-licensed physician. Federal healthcare program patients (e.g., Medicare, Medicaid) are **not eligible**[2][6]. Your doctor must certify that Bavencio is medically appropriate and supervise your treatment[2][5]. ## Income Eligibility Eligibility is based on **household income** (before taxes, including wages, Social Security, unemployment, etc.) compared to Federal Poverty Level (FPL), though exact percentages aren't specified publicly—"certain income eligibility" applies[1][2]. Provide proof for your household size. | Household Size | Estimated Income Threshold (e.g., <400-500% FPL, verify with program) | Required Proof | |---------------|---------------------------------------------------------------|---------------| | 1 (Individual) | Contact program for exact limit | Tax return/W-2 or alternatives | | 2 (Couple) | Contact program for exact limit | Same | | 3 | Contact program for exact limit | Same | | 4+ | Contact program for exact limit; add ~$5,000 per person | Same | **Notes:** Income docs: Most recent Federal/State tax return (e.g., IRS 1040), W-2, 2 months paycheck stubs, 2 months bank statements (showing deposits), Social Security/unemployment statements[1][2][4]. Household income includes all sources[2]. ## Insurance Requirements **Uninsured only**—no coverage for Bavencio from private insurance, Medicare, Medicaid, or other federal/state programs[1][2][6]. If you gain Medicare coverage, eligibility expires Dec 31; reapply next year[2]. Underinsured may qualify in some cases, but primarily for uninsured[2]. ## Step-by-Step Application Process 1. **Talk to Your Doctor:** Ask if Bavencio is appropriate. They complete the **CoverOne Enrollment Form** with your diagnosis (ICD-10 codes), prior therapies, planned treatment dates, and prescription[2][4][5]. 2. **Gather Documents:** - Proof of income (see table above)[1][2] - Proof of no insurance (e.g., denial letter if applicable) - Patient info: Name, address, DOB, household size/income[2] 3. **Submit Application:** Multiple methods—your provider submits via **CoverOne Enrollment Portal** or **faxes to 1-800-214-7295**[1][2][5]. Include signed form, prescription, and docs. Or call 1-844-8COVER1 (1-844-826-8371) for help[2]. 4. **Eligibility Review:** CoverOne reviews within days to weeks[1]. 5. **Approval Notification:** If approved, medication ships free to you or your doctor's office[1]. ## Timeline and Delivery Processing time varies (typically 1-2 weeks, but not specified—call for updates)[1]. Once approved, **Bavencio ships directly to the patient** at no cost[1]. Your doctor administers it. Reauthorization may be needed annually or per cycle—check with program[2]. ## If Denied or Alternatives **If denied:** Common reasons—over income, insured status, incomplete docs. Contact CoverOne at 1-844-826-8371 to appeal or resubmit[2]. Explore: - **Co-Pay Program** (for commercially insured, not this program)[6][7] - Independent foundations (e.g., via RxAssist.org)[8] - Specialty pharmacies like AmeriPharma for copay aid[9] - Biosimilars: None currently available[] - State programs or clinical trials via your doctor. Work with your oncology team for other support. ## Important Disclaimer This guide is for informational purposes based on publicly available data as of 2026[1][2]. Eligibility rules can change—**always verify directly with CoverOne at 1-844-8COVER1 or coverone.com**. Not medical/financial advice. Consult your doctor for treatment decisions. Program not for federal program patients[6]. Pfizer/CoverOne may update terms; participation voluntary[5]. (Word count: 942)

Program information last verified: March 30, 2026