{"id":24140,"date":"2023-12-18T16:24:29","date_gmt":"2023-12-18T16:24:29","guid":{"rendered":"https:\/\/ameripharmaspecialty.com\/?page_id=24140"},"modified":"2026-04-17T09:35:47","modified_gmt":"2026-04-17T16:35:47","slug":"jivi-copay-assistance","status":"publish","type":"page","link":"https:\/\/ameripharmaspecialty.com\/vi\/jivi-copay-assistance\/","title":{"rendered":"Jivi Copay Assistance"},"content":{"rendered":"<style>\n\t@media screen and (min-width: 1023px) {\n\t\t.copayHeroBanner-image {\n\t\t\tposition: absolute;\n\t\t\ttop: 0;\n\t\t\tleft: 0;\n\t\t\twidth: 100%;\n\t\t\theight: 100%;\n\t\t\tz-index: -1;\n\t\t}\n\n\t\t.copayHeroBanner-image img {\n\t\t\tobject-fit: cover;\n\t\t\theight: 100%;\n\t\t\twidth: 100%;\n\t\t}\n\t}\n<\/style>\n\n<div  id=\"copay-hero-banner-ea174cde367b3b9a74c5603b93ea97e0\" style=\"\" class=\"copayHeroBanner\">\n\t<div class=\"container\">\n\t\t<div class=\"banner-wrap \">\n\t\t\t<div class=\"content\">\n\t\t\t\t<p id=\"breadcrumbs\"><span><span><a href=\"https:\/\/ameripharmaspecialty.com\/\">Home<\/a><\/span><\/span><\/p>\t\t\t\t<h2 class=\"title\">Get Financial Relief Now<\/h2>\n\t\t\t\t<p class=\"text\">Apply for Jivi Copay Assistance<\/p>\n\n\t\t\t\t<div class=\"list\">\n\t\t\t\t\t<ul>\n<li>Free service matches you with top copay assistance programs<\/li>\n<li>Specialists assist you throughout the application process<\/li>\n<li>Get automated updates on your funding status<\/li>\n<li>Over $55 million secured for our patients to date<\/li>\n<\/ul>\n\t\t\t\t<\/div>\n\n\t\t\t\t\n\t\t\t\t\t<div class=\"button-wrap\">\n\t\t\t\t\t\t<a class=\"button\" href=\"#form\" target=\"_self\">Talk To A Specialist<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t<picture class=\"copayHeroBanner-image\">\n\t\t\t\t<source media=\"(min-width:1023px)\" srcset=\"https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2023\/12\/copay-banner-desktop-scaled.jpeg\">\n\t\t<img decoding=\"async\" src=\"https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2023\/12\/copay-banner-mbile-no-gradient.jpeg\" alt=\"\">\n\t<\/picture>\n<\/div>\n\n\n<div  id=\"copay-how-it-works-23e31d31be85f83b3039e45ea8adf74e\" style=\"\" class=\"copayAssistanceWork\">\n\t<div class=\"container\">\n\t\t<div class=\"copayAssistanceWork-wrapper\">\n\t\t\t<div class=\"top-section\">\n\t\t\t\t<h2 class=\"title\">How Assistance Works<\/h2>\n\t\t\t\t<p class=\"subtext\">Streamlining our patient\u2019s specialty pharmacy experience with unmatched full-service convenience<\/p>\n\t\t\t<\/div>\n\t\t\t\t\t\t\t<ul class=\"bottom-section\">\n\t\t\t\t\t\t\t\t\t\t\t<li class=\"list-item\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"63\" height=\"55\" src=\"https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2023\/12\/step1.png\" class=\"attachment-full size-full\" alt=\"Coverage Verification Code\" \/>\t\t\t\t\t\t\t<div class=\"content\">\n\t\t\t\t\t\t\t\t<h4 class=\"step-title\">1. Check Your Coverage\/Benefits Verification<\/h4>\n\t\t\t\t\t\t\t\t<p class=\"description\">Our team of expert billers finds the best avenues of coverage that minimize out-of-pocket costs.<\/p>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t\t\t\t<li class=\"list-item\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"63\" height=\"55\" src=\"https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2023\/12\/step2.png\" class=\"attachment-full size-full\" alt=\"Transfer Prescription to AmeriPharma - Image\" \/>\t\t\t\t\t\t\t<div class=\"content\">\n\t\t\t\t\t\t\t\t<h4 class=\"step-title\">2. Transfer Prescription to AmeriPharma\u00ae<\/h4>\n\t\t\t\t\t\t\t\t<p class=\"description\">We process your prescription by working with your previous pharmacy or prescriber, making the transition quick and easy.<\/p>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t\t\t\t<li class=\"list-item\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"63\" height=\"55\" src=\"https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2023\/12\/step3.png\" class=\"attachment-full size-full\" alt=\"Icon - Eligard copay assistance process\" \/>\t\t\t\t\t\t\t<div class=\"content\">\n\t\t\t\t\t\t\t\t<h4 class=\"step-title\">3. Prior Authorization<\/h4>\n\t\t\t\t\t\t\t\t<p class=\"description\">Our team of specialists obtains approval from your insurance companies within 24 to 72 hours.<\/p>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t\t\t\t<li class=\"list-item\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"63\" height=\"55\" src=\"https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2023\/12\/step4.png\" class=\"attachment-full size-full\" alt=\"Eligard Copay Financial Assistance Icon\" \/>\t\t\t\t\t\t\t<div class=\"content\">\n\t\t\t\t\t\t\t\t<h4 class=\"step-title\">4. Copay Assistance &#038; Financial Aid<\/h4>\n\t\t\t\t\t\t\t\t<p class=\"description\">We secure financial aid and decrease copays, out-of-pocket expenses, and high deductibles. To date, AmeriPharma\u00ae Specialty Care has secured $55 million in financial assistance for our patients.<\/p>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t\t\t\t<li class=\"list-item\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"63\" height=\"55\" src=\"https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2023\/12\/step5.png\" class=\"attachment-full size-full\" alt=\"Nursing Care Logo\" \/>\t\t\t\t\t\t\t<div class=\"content\">\n\t\t\t\t\t\t\t\t<h4 class=\"step-title\">5. Nursing Care Coordination If Needed<\/h4>\n\t\t\t\t\t\t\t\t<p class=\"description\">AmeriPharma\u00ae puts your schedule and home environment first when scheduling and coordinating one of our specialized nurses for your in-home infusions.<\/p>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t\t\t\t<li class=\"list-item\">\n\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"63\" height=\"55\" src=\"https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2023\/12\/step6.png\" class=\"attachment-full size-full\" alt=\"Delivery Coordination - Image\" \/>\t\t\t\t\t\t\t<div class=\"content\">\n\t\t\t\t\t\t\t\t<h4 class=\"step-title\">6. Delivery Coordination<\/h4>\n\t\t\t\t\t\t\t\t<p class=\"description\">Medications are always delivered in strict compliance with the specific requirements for shipping. Next-day and overnight cold-chain deliveries are coordinated around your schedule.<\/p>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\n<div  id=\"image-with-text-22e14584abeb2e899bea214f5724d623\" style=\"\" class=\"small-photo ct_image_with_text\">\n        <div class=\"container\">\n        <div class=\"block-spacing block-wrap image_with_text \">\n                            <div class=\"image_with_text_content\">\n                    <h2 class=\"wp-block-heading\"><strong>What Is Jivi?<\/strong><\/h2>\n<p>Jivi (damoctocog alfa pegol) is an FDA-approved medicine used to control or prevent bleeding episodes in patients with Hemophilia A. Hemophilia A is a genetic disorder caused by a lack of clotting factor VIII (a protein needed for normal blood clotting).<\/p>\n<p>Jivi is a man-made version of clotting factor VIII that is chemically modified to last longer in the body. It was developed by Bayer, and the FDA first approved it in August 2018 for use in children and adults with Hemophilia A.<\/p>\n<p>You can get this medication through an IV infusion, and it is designed to give you longer protection compared to other factor VIII products.<\/p>\n                <\/div>\n                                        <div class=\"image_with_text_media\">\n                    <picture>\n                                                <source loading=\"lazy\" media=\"(min-width:768px)\" srcset=\"https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2024\/02\/pharmacist.jpg\">\n                        <img decoding=\"async\" loading=\"lazy\" src=\"https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2024\/02\/block_image_mobile.jpg\" alt=\"https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2024\/02\/pharmacist.jpg\" style=\"width:auto;\">\n                    <\/picture>\n                <\/div>\n                    <\/div>\n    <\/div>\n<\/div>\n\n\n<div  id=\"image-30-text-70-69c8963be9c8bf25abc8fd5d3ab72129\" style=\"\" class=\"img30text70 light_gray\">\n\t<div class=\"container\">\n\t\t<div class=\"block-wrap left\">\n\t\t\t<div class=\"block-column image\">\n\t\t\t\t<picture class=\"image-30\">\n\t\t\t\t\t\t\t\t\t\t<source loading=\"lazy\" media=\"(min-width:768px)\" srcset=\"https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2024\/02\/block_image_1.jpg\">\n\t\t\t\t\t<img decoding=\"async\" loading=\"lazy\" src=\"https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2024\/02\/block-image-2.jpeg\" alt=\"https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2024\/02\/block_image_1.jpg\" style=\"width:auto;\">\n\t\t\t\t<\/picture>\n\t\t\t<\/div>\n\t\t\t<div class=\"block-column\">\n\t\t\t\t<div class=\"text\">\n\t\t\t\t\t<div class=\"wpb_text_column wpb_content_element\">\n<div class=\"wpb_wrapper\">\n<h2 class=\"wp-block-heading\"><strong>What Is Jivi Used To Treat?<\/strong><\/h2>\n<p>Jivi is a factor VIII replacement medicine. Factor VIII is a protein that is needed to clot blood properly. Jivi is used to treat people with hemophilia A, a condition where the body does not have enough factor VIII.<\/p>\n<p>Jivi can be used in adults and children aged 7 or older who have taken factor VIII replacement therapy before. It is FDA-approved for:<\/p>\n<ul class=\"wp-block-list\">\n<li>Treating bleeding episodes when they happen<\/li>\n<li>Controlling bleeding during and after a surgery<\/li>\n<li>Regular preventive treatment to reduce the frequency of bleeding episodes<\/li>\n<\/ul>\n<p>Please note that Jivi is not recommended for children under 7 years of age, people who never received factor VIII therapy, or people who have\u00a0<a href=\"https:\/\/www.mayoclinic.org\/diseases-conditions\/von-willebrand-disease\/symptoms-causes\/syc-20354978\">Von Willebrand disease<\/a>.<\/p>\n<h2 class=\"wp-block-heading\"><strong>How Does Jivi Work?<\/strong><\/h2>\n<p>Factor VIII is a protein that your body needs to form blood clots properly. In people with hemophilia A, the body does not produce enough functional factor VIII. As a result, they experience prolonged or frequent bleeding episodes.<\/p>\n<p>Jivi is a laboratory-made factor VIII medicine. It works by replacing the missing clotting factor VIII in people with hemophilia A. The notable feature of Jivi is that it has been modified by attaching it to a substance called PEG (polyethylene glycol). This modification slows down the rate at which Jivi is removed from the body.<\/p>\n<p>As a result, Jivi stays in your bloodstream for a longer time. Thus, you get longer-lasting protection against bleeding.<\/p>\n<\/div>\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\n<div  id=\"copay-assistance-7bd4fa627b7846d74bc73a14d5c98666\" style=\"\" class=\"copayAssistance\">\n\t<div class=\"container\">\n\t\t<div class=\"copayAssistanceWrap\">\n\t\t\t<h2 class=\"title\">Copay and Financial Assistance<\/h2>\n\t\t\t<p class=\"text\">AmeriPharma\u00ae Specialty Pharmacy alleviates financial burdens for patients and their families<\/p>\n\t\t\t\t\t\t\t<ul class=\"list\">\n\t\t\t\t\t\t\t\t\t\t\t<li class=\"list-item\">\n\t\t\t\t\t\t\t<div class=\"icon\">\n\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"75\" height=\"75\" src=\"https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2023\/11\/icon1-1.png\" class=\"attachment-full size-full\" alt=\"Advanced software Icon\" \/>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<p class=\"sub-text\">Advanced software locates funding sources to match you with top-dollar foundation programs<\/p>\n\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t\t\t\t<li class=\"list-item\">\n\t\t\t\t\t\t\t<div class=\"icon\">\n\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"67\" height=\"66\" src=\"https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2023\/11\/icon2.png\" class=\"attachment-full size-full\" alt=\"Copay and Financial Assistance\" \/>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<p class=\"sub-text\">One of our copay assistance specialists will assist with the application process<\/p>\n\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t\t\t\t<li class=\"list-item\">\n\t\t\t\t\t\t\t<div class=\"icon\">\n\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"75\" height=\"75\" src=\"https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2023\/11\/icon3.png\" class=\"attachment-full size-full\" alt=\"Funding Icon\" \/>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<p class=\"sub-text\">Automatic updates will be sent to you and your physician on the status of the funding<\/p>\n\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\n\n<div  id=\"image-30-text-70-3f26884ef814d4aaae774c8555d7fc78\" style=\"\" class=\"img30text70 white\">\n\t<div class=\"container\">\n\t\t<div class=\"block-wrap right\">\n\t\t\t<div class=\"block-column image\">\n\t\t\t\t<picture class=\"image-30\">\n\t\t\t\t\t\t\t\t\t\t<source loading=\"lazy\" media=\"(min-width:768px)\" srcset=\"https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2024\/02\/Mask-Group-45-1.jpg\">\n\t\t\t\t\t<img decoding=\"async\" loading=\"lazy\" src=\"https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2024\/02\/Mask-Group-45-2.jpg\" alt=\"https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2024\/02\/Mask-Group-45-1.jpg\" style=\"width:auto;\">\n\t\t\t\t<\/picture>\n\t\t\t<\/div>\n\t\t\t<div class=\"block-column\">\n\t\t\t\t<div class=\"text\">\n\t\t\t\t\t<div class=\"wpb_text_column wpb_content_element\">\n<div class=\"wpb_wrapper\">\n<h2 class=\"wp-block-heading\"><strong>Dosing<\/strong><\/h2>\n<p>Jivi is available as a lyophilized powder in single-dose vials. Your doctor will reconstitute it before using. You will receive this drug through intravenous infusion. The dosage and frequency of Jivi infusion depend on your weight, the severity of your disease, and your treatment goal. Here is the usual recommended dosage of Jivi:<\/p>\n<p><strong>Treatment of Bleeding Episodes and Surgical Use:<\/strong>\u00a0The dosing is based on how much the patient\u2019s factor VIII level needs to increase. The required dose is calculated using your body weight and the desired increase in factor VIII activity. Your doctor will determine the right dose for you.<\/p>\n<p><strong>Prevention of Bleeding:<\/strong>\u00a0Here is the usual dosage that you must take regularly to prevent bleeding:<\/p>\n<ul class=\"wp-block-list\">\n<li>For adults and children aged 12 years or older, the usual starting dose is 30-40 IU\/kg twice weekly. If bleeding continues, the dosage can be adjusted to 45-60 IU\/kg every 5 days.<\/li>\n<li>For children aged 7-11 years, the recommended starting dose is 60 IU\/kg. Your doctor will adjust the dose based on clinical response and factor VIII recovery.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\n<div  id=\"copay-side-effect-list-3935a1746b4e9fa3365e5f9edcfdcfd7\" style=\"\" class=\"copaySideEffectList\">\n\t<div class=\"container\">\n\t\t<h2 class=\"title\">Jivi Side Effects<\/h2>\n\t\t<div class=\"content  sideEffectList\" id=\"sideEffectList\">\n\t\t\t<h5><strong>Common side effects include:<\/strong><\/h5>\n<ul>\n<li>Fever<\/li>\n<li>Cough<\/li>\n<li>Headache<\/li>\n<li>Abdominal pain<\/li>\n<\/ul>\n<h3><\/h3>\n<h5 class=\"wp-block-heading\"><strong>Serious Side Effects<\/strong><\/h5>\n<p>Although rare, Jivi can cause serious side effects. Here are some of them:<\/p>\n<p><strong>Severe Allergic Reactions:<\/strong>\u00a0Jivi can cause allergic reactions, which can be severe. Symptoms include rash, itching, swelling of the face or throat, difficulty breathing, nausea or vomiting, and stomach cramps. If an allergic reaction occurs, stop using Jivi immediately and contact your doctor.<\/p>\n<p><strong>Development of Factor VIII Inhibitors:<\/strong>\u00a0You may develop inhibitors (antibodies) that reduce the effectiveness of Jivi. If bleeding does not stop as expected, your doctor may conduct a blood test to check the factor VIII levels in the blood to confirm whether they are lower than they should be.<\/p>\n<p><strong>Immune Reaction to PEG:<\/strong>\u00a0The immune system of some patients may react to PEG (a substance in Jivi). This can lead to sudden allergic reactions or make Jivi less effective.<\/p>\n<p>Please note that this is not a complete list of all possible side effects. If you experience any unusual or severe symptoms, contact your doctor immediately.<\/p>\n<div class=\"wpb_text_column wpb_content_element\">\n<div class=\"wpb_wrapper\"><\/div>\n<\/div>\n<div class=\"wpb_text_column wpb_content_element\">\n<div class=\"wpb_wrapper\"><\/div>\n<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n\n\n<div  id=\"copay-insurance-companies-9f6a0526841580f2cd71aa947382b9c5\" style=\"\" class=\"copayInsuranceCompanies\">\n\t<div class=\"container\">\n\t\t<h3 class=\"title\">Insurances Accepted<\/h3>\n\t\t<p class=\"text\">We accept Medicare, multi-state Medicaid, Medi-Cal, Blue Shield, and most private insurances. Call us to find out more about your coverage.<\/p>\n\t\t\t\t\t<ul class=\"list\">\n\t\t\t\t\t\t\t\t\t<li class=\"list-item\">\n\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"218\" height=\"34\" src=\"https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2024\/01\/medicare-footer-logo.png\" class=\"attachment-full size-full\" alt=\"Medicare logo displayed in the website footer.\" srcset=\"https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2024\/01\/medicare-footer-logo.png 218w, https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2024\/01\/medicare-footer-logo-86x13.png 86w, https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2024\/01\/medicare-footer-logo-167x26.png 167w\" sizes=\"auto, (max-width: 218px) 100vw, 218px\" \/>\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t\t<li class=\"list-item\">\n\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"270\" height=\"58\" src=\"https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2024\/07\/medicaid-gov-logo.png\" class=\"attachment-full size-full\" alt=\"Medicaid logo\" srcset=\"https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2024\/07\/medicaid-gov-logo.png 270w, https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2024\/07\/medicaid-gov-logo-86x18.png 86w, https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2024\/07\/medicaid-gov-logo-167x36.png 167w\" sizes=\"auto, (max-width: 270px) 100vw, 270px\" \/>\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t\t<li class=\"list-item\">\n\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"200\" height=\"104\" src=\"https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2023\/11\/Image-137.png\" class=\"attachment-full size-full\" alt=\"Blue Cross Blue Shield Logo\" srcset=\"https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2023\/11\/Image-137.png 200w, https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2023\/11\/Image-137-86x45.png 86w, https:\/\/ameripharmaspecialty.com\/wp-content\/uploads\/2023\/11\/Image-137-167x87.png 167w\" sizes=\"auto, (max-width: 200px) 100vw, 200px\" \/>\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t<\/ul>\n\t\t\t<\/div>\n<\/div>\n\n\n\n<div id=\"form\">\n\t<div  id=\"copay-form-9cfa2480990687d87ede867ad8f09732\" style=\"\" class=\"copayForm\">\n\t\t<div class=\"container\">\n\t\t\t<div class=\"copayForm-wrapper\">\n\t\t\t\t<div class=\"content\">\n\n\t\t\t\t\t\t\t\t\t\t\t<h2 class=\"title\">Get Started in Minutes<\/h2>\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t<p class=\"text\">Fill out your information and one of our specialists will call you ASAP.<\/p>\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t<h3 class=\"question\">How Much Can You Save?<\/h3>\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t<p class=\"answer\">Complete this form to save up to 100%!<\/p>\n\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t<!--<a class=\"contact-button\" href=\"tel:8777780318\">(877) 778-0318<\/a>-->\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"form\">\n\t\t\t\t\t<div id=\"iframe-container\"><\/div>\n\t\t\t\t\t<script>     \n                        window.addEventListener('DOMContentLoaded', () => {\n                            function buildForm(posthogID) {\n                                let formId = 'Lac86iCjiIyfdFLJylVF';\n                                let formHeight = '400px';\n                                function getURLParameter(e){return decodeURIComponent((RegExp(e+\"=(.+?)(&|$)\").exec(location.search)||[,null])[1])}   \n                                let utmParams = ['utm_source','utm_medium','utm_campaign','utm_campaignid','utm_adgroup','utm_term','utm_keyword','keyword','device','match','loc','utm_network','gclid','extensionid', 'sitelink']; 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