Sandoz One Source™ 
Commercial Co-Pay Program for ZARXIO®
(filgrastim-sndz)

Created to support eligible,* commercially insured patients with their out-of-pocket Co-pay costs for ZARXIO

 

 

*Maximum benefit of $10,000 annually. Prescription must be for an approved indication. This program is not health insurance. This program is for insured patients only; cash-paying or uninsured patients are not eligible. Patients are not eligible if prescriptions are paid, in whole or in part, by any state or federally funded programs, including but not limited to Medicare (including Part D, even in the coverage gap) or Medicaid, Medigap, VA, DOD, or TriCare, or private indemnity plans that do not cover prescription drugs, or HMO insurance plans that reimburse the patient for the entire cost of their prescription drugs, or where prohibited by law. Patients can participate for a maximum of 12 months. Co-Pay Program may not be combined with any other rebate, coupon, or offer. Sandoz reserves the right to rescind, revoke, or amend this offer without further notice. 


One form to enroll for all services

Use the Sandoz One Source enrollment form to request patient-specific Reimbursement Services and to enroll patients in the Commercial Co-Pay Program. The Novartis Patient Assistance Foundation will also use this form to assess patients for the Patient Assistance Program (PAP) when applicable.


Get started in 3 easy steps:

Step 1. Submit Sandoz One Source enrollment form

  • Sandoz One Source conducts a benefit verification
  • Patient meets eligibility criteria and is enrolled

Step 2. Receive approval letter

Medical benefit:

  • Your patient will receive a welcome packet including Sandoz One Source Visa® information**
    • You will be sent the card information if patient consent was provided on enrollment form
    • Contact your patient to bring the card information to their next appointment if consent was not provided on enrollment form

Pharmacy benefit:

  • Include the following information from the approval letter when ordering
    • Patient identification number
    • Group number
    • BIN number

Step 3. Submit the claim

Medical benefit:

  • Submit explanation of benefits (EOB) to Sandoz One Source
  • Sandoz One Source will review EOB, load co-pay amount onto patient’s Visa®, and notify you when co-pay benefit is available

Pharmacy benefit:

  • An electronic claim is submitted by the pharmacy
  • Sandoz One Source will process co-pay claim upon receipt

Sandoz One Source Commercial Co-Pay Brochure for ZARXIO

Provides contact information for Sandoz One Source and explains how to enroll patients in the Co-Pay Program. 

Sandoz One Source Commercial Co-Pay Program for ZARXIO: Enrollment Steps

A quick reminder of how to enroll patients in the Commercial Co-Pay Program for ZARXIO.

Contact Sandoz One Source

Phone

  • 1-844-SANDOZ1
  • (1-844-726-3691)
  • M-F 9AM to 8PM ET

Fax

  • 1-844-726-3695

Address

  • PO Box 220188
  • Charlotte, NC 28222-0188

** The Sandoz One Source Visa® card number can only be used for the medical benefit.

The Sandoz One Source Visa® is issued by Metropolitan Commercial Bank (Member FDIC) pursuant to a license from Visa USA, Inc. "Metropolitan Commercial Bank" and "Metropolitan" are registered trademarks of Metropolitan Commercial Bank.© 2014. Use of the Card is subject to the terms and conditions of the applicable Cardholder Agreement and fee schedule, if any. Visa is a registered trademark of Visa International Service Association.

This website provides general information and is not intended to provide reimbursement or legal advice. Furthermore, it is not intended to increase or maximize payment by any payer. Because laws, regulations, and coverage policies are complex and updated frequently, you should check with your local Medicare carrier and payers often or go to www.cms.gov.

Nothing in the information provided shall be construed as a guarantee of Sandoz regarding levels of reimbursement, payment, or charge that reimbursement will be received. The ultimate responsibility for obtaining reimbursement lies with the physician, provider, or patient. Please consult with your counsel or reimbursement specialist for any practice-specific reimbursement or billing questions.