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Synvisc Connection Personalized Reimbursement Solutions
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PO Box 222138
Charlotte, NC 28222
Phone
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888-847-4877
Fax:
888-847-1797
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Eligibility
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Patients must be uninsured, be at or below 250% of the Federal Poverty Level, have osteoarthritis of the knee, be a US resident and have a social security number. |
| Who Can Apply
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Patients or healthcare providers can call to have an application faxed or download one. |
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Required
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Doctors must complete a section of the application and sign. Patients must complete a section of the application, sign and attach proof of income. |
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Supply
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Varies |
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Ship To
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Doctor's office |
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Note
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The doctor must only have two patients enrolled every six months.
Contact program for Spanish application. |
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
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| Synvisc-One syringe; prefilled |
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Printable Application Forms
Applications that patients can fill out and bring to their doctor.
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| Download printable Form |
(Requires Acrobat Reader) 
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