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To submit a medical co-pay claim you will need:

  • Explanation of Benefits (EOB) form for insured patients
  • Specific information regarding the patient, prescriber, date of therapy administration, etc.

Please note: You may only submit a claim if the patient is commercially insured and is not participating in Medicare Part D, VA, TriCare, CHAMPUS, Medicaid, or any other similar federal or state program.