Financial Assistance

Patient support services and
programs to assist with access

Commercially Insured

Commercially insured includes commercial, private, employer, and state-run health insurance exchanges. Coverage and reimbursement for patients with commercial insurance will vary based on health plan benefit design and provider contract.

Coherus COMPLETE^TM Co-Pay Assistance Program

Coherus COMPLETE^TM offers a Co-Pay Assistance Program that covers out-of-pocket expenses related to UDENYCA^® for commercially insured patients.

Eligible patients qualify for $0 out-of-pocket costs for each UDENYCA^® dose.*

$15,000 maximum
annual benefit
per enrollment
period
Electronic co‑pay claims submission through office billing software
No physical co-pay card required

Enroll in the Co-Pay Program

Submit Claims

Get Reimbursed

The Co-Pay Assistance Program has a 180-day look back period. Patients with commercial insurance, who have received UDENYCA in the past 6 months, may be eligible.

*Eligibility Criteria:

Must be prescribed UDENYCA^® for a medically appropriate use
Must have commercial health insurance that covers the medication costs of UDENYCA^®
Must not be covered by any federal, state, or government-funded healthcare program, such as Medicare, Medicaid, Medicare Advantage, Medicare Part D, Veterans Affairs, the Department of Defense, or TRICARE
Must not seek reimbursement amount received from Coherus from any third-party payers, including flexible spending accounts or healthcare savings accounts

If at any time a patient starts receiving coverage through a federal, state, or government-funded healthcare program, the patient will no longer be eligible for the program. The patient MUST contact Coherus COMPLETE^TM at 844-4-UDENYCA / (1-844-483-3692) to report the change in eligibility status.

The co-pay program only covers the costs of UDENYCA^® and does not cover any administration or office visit costs. Restrictions may apply and not valid where prohibited by law. Coherus may revise or terminate this program without notice at any time.

Setting Up Co-Pay Assistance Reimbursement

There are three ways for a provider to receive reimbursement for UDENYCA^® (pegfilgrastim‑cbqv) from the Co-Pay Assistance Program:

Payment Remittance: If you have an account with InstaMed^® and have elected to receive payments via ACH and electronic remittance, then approved claims will be paid via ACH. If you do not have an account with InstaMed^® or did not elect to receive ACH payments, then a physical check for approved claims will be mailed to the address on the claim form submitted for reimbursement.

There are 3 ways to set up an account to receive payments via ACH and electronic remittance:
a. Online: https://online.instamed.com/providers
b. Email: support@InstaMed.com
c. Call: InstaMed^® Support at 1-866-467-8263

Please contact InstaMed^® customer service directly at 1-866-467-8263 if you are unaware of your current InstaMed^® account status.

Enroll in the Co-Pay Program

Submit Claims

Get Reimbursed

Download the step by step guide on co-pay claim submission and reimbursement

Download The Virtual Debit Card Fax Coversheet

Payment Method	Steps Required
Physical Check	Check will be mailed to the address listed on the CMS‑1500 or CMS‑1450 claim form. Reimbursement to a specific site when provider has multiple locations.
Electronic Funds Transfer	If your practice has already elected to receive payments via ACH and electronic remittance for other payers, then approved claims will be paid via EFT. If you have not elected to receive payments electronically for other payers, please contact Coherus COMPLETE™ at 1-844-483-3692 for additional information.
Virtual Debit Card	Once the claim is approved, you will receive a Virtual Debit Card (VDC) Confirmation Fax. This fax will include: 16-digit VDC number 3-digit security code Associated zip code of 27560 Please use this information to process payment as you would any credit card or debit card payment.
Online	Submit claims through SmartData Solutions (SDS) website: Register and complete account setup with SDS. Someone from your IT department, claims processing software vendor, or EDI coordinator may be able to help. Navigate to https://quickclaim.smart-data-solutions.com/quickclaim/servlet/quickclaim/ and log in using your supplied credentials. Once you have gained portal access, you can submit the claims for the Coherus COMPLETE™ Co-Pay Assistance Program via the following means: Direct File Upload to the Portal Manual Claim Entry

Enroll in the Co-Pay Program

Submit Claims

Get Reimbursed

Download The Virtual Debit Card Fax Coversheet

Co-Pay Assistance Program Brochure

Download

For assistance with co-pay claims reimbursement, please contact
Coherus COMPLETE^TM at 1-844-4-UDENYCA (1-844-483-3692)

Commercially Insured

Setting Up Co-Pay Assistance Reimbursement

Co-Pay Assistance Program Brochure

Contact Us