Genentech BioOncology® Co-pay Card Assistance Program

• February 5, 2018
• News, Reimbursement

Eligible patients pay $5 for their prescribed Genentech BioOncology^®product(s)*

With the Genentech BioOncology^® Co-pay Assistance Program^†

Talk to eligible patients about enrolling today.

For FDA-approved Genentech BioOncology^® single and combination therapies.

Terms and conditions apply. Please scroll below for details.

Features and Benefits

$5

Patient pays a $5 co-pay for Genentech BioOncology^®product(s)

^$0

No income requirements

^$25K

12-month benefit limit of co-pay is $25,000 for each product

CHECK ELIGIBILITY

For patients with commercial (private or non-governmental) insurance, including exchange or marketplace plans, who are:

• ≥18 years
• Living/receiving care in the United States or Puerto Rico
• Using Genentech BioOncology® products per FDA-approved indications
• NOT for patients using Medicare, Medicaid, or other government-funded program to pay for medications
• NOT for patients currently receiving assistance through Genentech® Access to Care Foundation (GATCF) or another co-pay assistance foundation for the Genentech product
• NOT for uninsured patients

CHECK PARTICIPATING PRODUCTS (ORAL AND IV)

Log on to copayassistancenow.com to view all of the participating Genentech BioOncology^® products.

Patient Already on Therapy?
Program will cover Genentech BioOncology® product co-pays up to 120 days prior to enrollment.

Patient on Combined Therapy?
If an eligible patient is taking more than one Genentech BioOncology® product, the patient’s out-of-pocket expense is $5 for the FDA-approved Genentech combination therapy

*Patient must have met eligibility requirements when the product was received.

Easy Enrollment. Important Patient Benefits.
Talk to Eligible Patients About Enrolling Today

Terms & Conditions

By using the Genentech BioOncology® Co-pay Assistance program, the patient acknowledges and confirms that at the time of usage, (s)he is currently eligible and meet the criteria set forth in the terms and conditions described.

This Co-pay Card is valid ONLY for patients with commercial (private or nongovernmental) insurance. It is not valid for patients who are Government beneficiaries or whose medications are covered, in whole or in part, under Medicaid, Medicare Part A, B, C and/or D, TRICARE, CHAMPUS, Puerto Rico Government Health Insurance Plan, or any other state or federal healthcare program. Patients who become Government beneficiaries during their enrollment period will no longer be eligible for the program as of the date they become a Government beneficiary.

This Co-Pay Card program is not health insurance or a benefit plan. Distribution or use of the Co-pay Card does not obligate use or continuing use of any specific product or provider. Patient or guardian is responsible for reporting the receipt of all Co-pay Card program benefits or reimbursement received, to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the Co-pay Card program, as may be required.

The Co-pay Card is not valid for medications the patient receives for free or that are eligible to be reimbursed by private insurance plans or other healthcare or pharmaceutical assistance programs (such as: GATCF or any other charitable organization) that reimburse the patient in part or for the entire cost of his/her medication. Patient, guardian, pharmacist, prescriber and any other person using the Co-pay Card agree not to seek reimbursement for all or any part of the benefit received by the recipient through the offer.

The Co-pay Card will be accepted by participating pharmacies, physician offices or hospitals. To qualify for the benefits of this Co-pay Card program, the patient may be required to pay out-of-pocket expenses for each treatment. Once enrolled, this Co-Pay Card program will not honor claims with date of service or medication dispensing that precede program enrollment by more than 120 days. This Co-pay Card is only available with a valid prescription and cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription. Use of this Co-pay Card must be consistent with all relevant health insurance requirements and payer agreements. Participating patients, pharmacies, physician offices and hospitals are obligated to inform third-party payers about the use of the Co-pay Card as provided for under the applicable insurance or as otherwise required by contract or law. The Co-pay Card may not be sold, purchased, traded or offered for sale, purchase or trade. The Co-pay Card is limited to 1 per person during this offering period and is not transferable. This program expires within 12 months from enrollment. This program is not valid where prohibited by law. For Massachusetts’ residents, the Co-pay Card is not valid for any prescription drug that has an AB rated generic equivalent as determined by the United States Food and Drug Administration. For Massachusetts’ residents, this program shall expire on or before July 1, 2017

The patient or their guardian must be 18 years or older to receive Co-pay Card program assistance. This Co-pay Card program is: (1) Void if the card is reproduced; (2) Void where prohibited by law; (3) only valid in the United States and Puerto Rico; and (4) only valid for Genentech products. Healthcare providers may not advertise or otherwise use the program as a means of promoting their services or Genentech’s products to patients. Genentech, Inc. reserves the right to rescind, revoke, or amend the program without notice at any time.