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 a benefits investigation through BV360 Reimbursement Solution.

BV360 Reimbursement Solution

1-833-MyBV360 (692-8360)
MyBV360.com
Patient Assistance Program Form

Patient Assistance Eligibility Requirements

  • Patient must be 18 years of age or older.
  • Patient must have a valid prescription.
  • Patient must be a resident of the United States or U.S. Territories.
  • Patient must have no insurance coverage, or not enough coverage to pay for the Bioventus medication.
  • Patient income must fall below 300% of the Federal Poverty Level, which can be found on https://aspe.hhs.gov/poverty-guidelines
  • Patient must provide and prescriber must submit with this request a photocopy of one of the following documents that shows total annual income:
  • –  Previous year’s federal tax return (form 1040 or 1040EZ)
    –  Wage and tax statements (W-2 forms)
    –  Two recent paycheck stubs
    –  Social security, pension, or retirement statements (SSA-1099 or similar)

2019 Federal Poverty Guidelines

Family Size 300%
1 $37,470
2 $50,730
3 $63,990
4 $77,250
5 $90,510
6 $103,770
7 $117,030
8 $130,290

*For households with more than 8 people, add $4,420 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