Referrals to the ACTEMRA Co-pay Card Program
Co-pay card programs provide direct financial assistance to patients to help with their co-pays, co-insurance or other out-of-pocket costs. If eligible commercially insured patients need assistance with their out-of-pocket costs, Genentech Rheumatology Access Solutions can refer them to the ACTEMRA Co-pay Card Program.
Patients who qualify can receive up to $15,000 in assistance per 12-month period. They pay $5 per drug co-pay or co-insurance until the annual limit is reached.
To get started, call (855) RA-COPAY (855-722-6729) or visit RACopay.com.
The ACTEMRA Co-pay Card Program is available only for commercially
insured patients. Patients using Medicare, Medicaid or any other
government-funded program to pay for their medications are not
eligible. It requires a valid, on-label prescription and cannot be
combined with any other rebate/coupon, free trial or similar offer
for the specified prescription. It is available only for a patient
(or their guardian) who is 18 years or older. It is not valid for
medications the patient receives for free or that are eligible to be
reimbursed by private insurance plans or other health care or
pharmaceutical assistance programs that reimburse the patient in
whole or in part for the medication. It is valid only for Genentech
products in the United States and Puerto Rico. The ACTEMRA Co-pay
Card Program is not health insurance or a benefit plan. Please see
full terms and conditions at RACopay.com.
PAN=Patient Authorization and Notice of Request
for Transmission of Health Information to Genentech Access Solutions
and Genentech® Access to Care Foundation.
SMN=Statement of Medical Necessity.
Important Safety Information & Indication
ACTEMRA® (tocilizumab) is indicated for the treatment of:
- Adult patients with moderately to severely active rheumatoid arthritis (RA) who have had an inadequate response to one or more Disease-Modifying Anti-Rheumatic Drugs (DMARDs)
- Giant cell arteritis (GCA) in adult patients
- Active polyarticular juvenile idiopathic arthritis in patients 2 years of age and older
- Active systemic juvenile idiopathic arthritis in patients 2 years of age and older
- Chimeric antigen receptor (CAR) T cell-induced severe or life-threatening cytokine release syndrome in adults and pediatric patients 2 years of age and older
Important Safety Information
RISK OF SERIOUS INFECTIONS:
Patients treated with ACTEMRA are at increased risk for developing serious infections that may lead to hospitalization or death, including tuberculosis (TB), bacterial, invasive fungal, viral, or other opportunistic infections. If a serious infection develops, interrupt ACTEMRA until the infection is controlled.
Reported infections include:
- Active tuberculosis, which may present with pulmonary or extrapulmonary disease. Patients should be tested for latent tuberculosis before ACTEMRA use and during therapy. Treatment for latent infection should be initiated prior to ACTEMRA use.
- Invasive fungal infections, including candidiasis, aspergillosis, and pneumocystis. Patients with invasive fungal infections may present with disseminated, rather than localized, disease.
- Bacterial, viral and other infections due to opportunistic pathogens.
The risks and benefits of treatment with ACTEMRA should be carefully considered prior to initiating therapy in patients with chronic or recurrent infection.
Patients should be closely monitored for the development of signs and symptoms of infection during and after treatment with ACTEMRA, including the possible development of tuberculosis in patients who tested negative for latent tuberculosis infection prior to initiating therapy.
ACTEMRA is contraindicated in patients with known hypersensitivity to ACTEMRA.
Other serious or potentially life-threatening adverse reactions that have been reported in clinical trials with ACTEMRA include gastrointestinal perforations. Use ACTEMRA with caution in patients who may be at risk for GI perforations.
Laboratory monitoring is recommended due to potential consequences of treatment-related laboratory abnormalities in neutrophils, platelets, lipids, and liver function tests.
ACTEMRA is an immunosuppressant, and treatment with immunosuppressants may result in an increased risk of malignancies.
Hypersensitivity reactions, including anaphylaxis and death, have occurred.
- If anaphylaxis or other hypersensitivity reaction occurs, stop administration of ACTEMRA immediately and discontinue ACTEMRA permanently.
The impact of treatment with ACTEMRA on demyelinating disorders is not known. Monitor patients for signs and symptoms potentially indicative of demyelinating disorders.
Treatment with ACTEMRA is not recommended in patients with active hepatic disease or hepatic impairment.
Avoid use of live vaccines concurrently with ACTEMRA, as clinical safety has not been established.
Most common adverse reactions included upper respiratory tract infections, nasopharyngitis, headache, hypertension, increased ALT, and injection-site reactions (SC only).
You may report side effects to the FDA at (800) FDA-1088 or http://www.fda.gov/medwatch. You may also report side effects to Genentech at (888) 835-2555.
Please see the full Prescribing Information, including BOXED WARNING, for additional Important Safety Information.