Patient Assistance Program
Bioventus is committed to providing access to SUPARTZ FX, GELSYN-3 and DUROLANE to patients without the financial resources to pay for the treatment by providing Patient Assistance Product at no cost. To request assistance for treatment of a patient, please complete and return one of the following Patient Assistance Forms to Bioventus Active Healing Therapies Customer Service via fax (866.832.7284) or email (CustomerServiceUSA@bioventusglobal.com).
Patient Assistance Forms
Patient Assistance Eligibility Requirements
- A Patient Assistance Form must be submitted for each patient.
- Patient must have an annual income of ≤250% of the current Federal Poverty Level.
2018 Federal Poverty Guidelines
*For households with more than 8 people, add $4,320 for each additional person per year. Chart is for 48 contiguous states and the District of Columbia; for Hawaii and Alaska please visit http://aspe.hhs.gov