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.