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Patient Assistance Information

 
1 Program for Synvisc-One syringe; prefilled
 
 
Synvisc Connection Personalized Reimbursement Solutions

PO Box 222138
Charlotte, NC 28222
Phone : 888-847-4877
Fax: 888-847-1797
Eligibility
> 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
> Patients or healthcare providers can call to have an application faxed or download one.
Required
> Doctors must complete a section of the application and sign. Patients must complete a section of the application, sign and attach proof of income.
Supply
> Varies
Ship To
> Doctor's office
Note
> The doctor must only have two patients enrolled every six months. Contact program for Spanish application.
 
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.
 
Synvisc-One syringe; prefilled
 
Printable Application Forms
Applications that patients can fill out and bring to their doctor.
 
Download printable Form
(Requires Acrobat Reader