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

• SUPARTZ FX Patient Assistance Form
• GELSYN-3 Patient Assistance Form
• DUROLANE Patient Assistance Form

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

Family Size 250%
1 $30,350
2 $41,150
3 $51,950
4 $62,750
5 $73,550
6 $84,350
7 $95,150
8 $105,950

*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