Contact info
- Phone
- 1-800-982-8292
- Fax
- 1-888-847-1797
- Mailing address
- PO Box 222138Charlotte, NC 28222-2138
Eligibility
- Patient must not have insurance coverage or not have access to the prescribed product or treatment via their insurance.
- Patient must have Osteoarthritis of the knee.
- Patient must be under the care of a licensed healthcare provider who is authorized to prescribe, dispense, and administer medicine in the US.
- Income limit, single
- 400% of the federal poverty level
- Income limit, couple
- 400% of the federal poverty level
- Medical expenses can be deducted
- Not published
- Social Security number asked for
- Yes
- US citizenship or residency required
- Yes
Not sure where your income falls? See this year's federal poverty guidelines (opens in a new tab).
Application process
- Documents to attach
- Proof of income
- Prescriber license number
- NPI number
- DEA number
- State license number
- Who can sign
- Physician
- Application can be faxed
- Yes
- Decision letter sent to
- Provider and patient
Getting the medication
- Patient receives
- Medication
- Shipped to
- Provider
- Supply per shipment
- Not published
- Time to first delivery
- 3–4 weeks
- Refills
- Not published
- Staying enrolled
- Not published
Medications covered
- Synvisc (hyaluronic acid derivatives)
- Synvisc-One Injection (hylan G-F 20)