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To submit a co-pay claim you will need:

  • A EUFLEXXA Relief account (create account)
  • Explanation of Benefits (EOB) or itemized receipt inclusive of patient portion paid to the Health Care Provider (HCP)
  • A signed copy of the EUFLEXXA Relief Form

To create your account, you will need:

  • An image of the front and back of your insurance card

Please note: You may only submit a claim if you have a commercial insurance and are not a participant of Medicare Part D, VA, TriCare, CHAMPUS, Medicaid, or any other similar federal or state program.