Referrals to the HEMLIBRA Co-pay Program
Co-pay 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, HEMLIBRA Access Solutions can refer them to the HEMLIBRA Co-pay Program.
To get started, call (844) HEM-COPAY (844-436-2672) or visit HEMLIBRACopay.com.
The HEMLIBRA Co-pay Program is available only for commercially
insured patients. Patients using Medicare, Medicaid, Medigap,
Veteran's Affairs (VA), Department of Defense (DoD), TriCare or any
other government-funded program to pay for their medications are not
eligible. Patients who start utilizing their government coverage
during their enrollment period will no longer be eligible for the
program. 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 US Territories. The HEMLIBRA
Co-pay Program is not health insurance or a benefit plan. Please see
full terms and conditions at HEMLIBRACopay.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
HEMLIBRA is indicated for routine prophylaxis to prevent or reduce the frequency of bleeding episodes in adult and pediatric patients ages newborn and older with hemophilia A with or without factor VIII inhibitors.
Important Safety Information
Boxed WARNING: THROMBOTIC MICROANGIOPATHY and THROMBOEMBOLISM
Cases of thrombotic microangiopathy and thrombotic events were reported when on average a cumulative amount of >100 U/kg/24 hours of activated prothrombin complex concentrate (aPCC) was administered for 24 hours or more to patients receiving HEMLIBRA prophylaxis. Monitor for the development of thrombotic microangiopathy and thrombotic events if aPCC is administered. Discontinue aPCC and suspend dosing of HEMLIBRA if symptoms occur.
Warnings and Precautions
- Laboratory coagulation test interference: HEMLIBRA interferes with activated clotting time (ACT); activated partial thromboplastin time (aPTT); and coagulation laboratory tests based on aPTT, including one-stage, aPTT-based single-factor assays; aPTT-based Activated Protein C Resistance (APC-R); and Bethesda assays (clotting-based) for factor VIII (FVIII) inhibitor titers. Intrinsic pathway clotting-based laboratory tests should not be used
Most Common Adverse Reactions
The most common adverse reactions (incidence ≥10%) are injection site reactions, headache, and arthralgia.
You may report side effects to the FDA at (800) FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at (888) 835-2555.
Please see the HEMLIBRA full Prescribing Information for additional Important Safety Information, including Boxed WARNING.