Terms and Conditions for Drug Assistance

This OCREVUS Co-pay Program is valid ONLY for patients with commercial (private or non-governmental) insurance who have a valid prescription for a Food and Drug Administration (FDA)-approved indication of a Genentech medication. Patients using Medicare, Medicaid, Medigap, Veteran's Affairs (VA), Department of Defense (DoD), TRICARE or any other federal or state government program to pay for their medications are not eligible. The Program is not valid for medications that are eligible to be reimbursed in their entirety by private insurance plans or other programs.

Under the Program, the patient will pay a co-pay. After reaching the maximum Program benefit, the patient will be responsible for all out-of-pocket costs. This Program is not health insurance or a benefit plan. The Program does not obligate the use of any specific product or provider. Patients receiving assistance from charitable assistance programs (such as Genentech Patient Foundation) are not eligible. The Co-pay benefit cannot be combined with any other rebate, free trial, or similar offer for the medication. No party may seek reimbursement for all or any part of the benefit received through this Program.

The Program may be accepted by participating pharmacies, physician offices, or hospitals. Once enrolled, this Program will not honor claims with date of service or medication dispensing that precede Program enrollment by more than 120 days. Use of this Program must be consistent with all relevant health insurance requirements. Participating patients, pharmacies, physician offices, and hospitals are responsible for reporting the receipt of all Program benefits as required by any insurer or by law. Program benefits may not be sold, purchased, traded, or offered for sale, purchase, or trade.

The patient or their guardian must be 18 years or older for the patient to be eligible. This Program is only valid in the United States and U.S. Territories. This Program is void where prohibited by law and shall follow state restrictions in relation to AB-rated generic equivalents (e.g. MA, CA) where applicable. Program eligibility is contingent upon the patient's ability to meet and maintain all requirements set forth by the Program. Genentech reserves the right to rescind, revoke, or amend the Program without notice at any time.

Terms and Conditions for Infusion Assistance

By using the OCREVUS Infusion Co-pay 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 below. If you choose to enroll in the OCREVUS Drug Co-pay Program, you must enroll into that program separately and meet all eligibility criteria.

This Infusion Co-pay Program is valid ONLY for patients with commercial (private or non-governmental) insurance. Patients using Medicare, Medicaid, or any other federal or state government funded program (collectively, "Government Programs") to pay for their medications are not eligible. Patients who start utilizing any Government coverage during their enrollment period will no longer be eligible for the program. The Infusion Co-pay Program is not valid for Massachusetts, Michigan, Minnesota, or Rhode Island residents.

This Infusion Co-pay Program is not health insurance or a benefit plan. Distribution or use of the Infusion 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 Infusion Co-pay 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 Infusion Co-pay Program, as may be required.

The Infusion Co-pay Program is valid for medications the patient receives for free from Genentech. The Infusion Co-pay Program is not valid for medications the patient receives for free or is otherwise subsidized by a non-Genentech charitable organization or healthcare plan. Patient, guardian, prescriber, hospital, and any other person using or administering the Infusion Co-pay Program agree not to seek reimbursement for any part of the benefit received by the recipient through the offer.

The Infusion Co-pay Program will be accepted by participating physician offices or hospitals. To qualify for the benefits of this Infusion Co-pay Program, the patient may be required to pay out-of-pocket expenses for each infusion. The amount of the Infusion Co-pay benefit cannot exceed the patient's out-of-pocket expenses for the cost of infusion with OCREVUS. [Once enrolled, this Infusion Co-pay Program will not honor claims with date of service or medication dispensing that precede program enrollment by more than 120 days.] This Infusion Co-pay Program is only available with a valid prescription for OCREVUS and cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription, except the OCREVUS Drug Co-pay Program.

Use of this Infusion Co-pay Program must be consistent with all relevant health insurance requirements and payer agreements. Participating patients, physician offices, and hospitals are obligated to inform third-party payers about the use of the Infusion Co-pay Program as provided for under the applicable insurance or as otherwise required by contract or law. The Infusion Co-pay Program may not be sold, purchased, traded or offered for sale, purchase or trade. The Infusion Co-pay Program 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.

The patient or their guardian must be 18 years or older to receive Infusion Co-pay Program assistance. This Infusion Co-pay Program is: (1) Void if the card is reproduced; (2) Void where prohibited by law; (3) only valid in the United States and U.S. Territories; and (4) only valid for infusion with OCREVUS. 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.

Indication and Important Safety Information

What is OCREVUS?

OCREVUS is a prescription medicine used to treat adults with relapsing or primary progressive forms of multiple sclerosis. It is not known if OCREVUS is safe or effective in children.

Who should not receive OCREVUS?

Do not receive OCREVUS if you have an active hepatitis B virus (HBV) infection.
Do not receive OCREVUS if you have had a life threatening allergic reaction to OCREVUS. Tell your healthcare provider if you have had an allergic reaction to OCREVUS or any of its ingredients in the past.

What is the most important information I should know about OCREVUS?

OCREVUS can cause serious side effects, including:

  • Infusion reactions: OCREVUS can cause infusion reactions that can be serious and require you to be hospitalized. You will be monitored during your infusion and for at least 1 hour after each infusion of OCREVUS for signs and symptoms of an infusion reaction.
  • Infection: OCREVUS increases your risk of getting upper respiratory tract infections, lower respiratory tract infections, skin infections, and herpes infections. If you have an active infection, your healthcare provider should delay your treatment with OCREVUS until your infection is gone.

What are the possible side effects of OCREVUS?

OCREVUS may cause serious side effects, including:

  • Risk of cancers (malignancies) including breast cancer. Follow your healthcare provider’s instructions about standard screening guidelines for breast cancer.

Most common side effects include infusion reactions and infections.

These are not all the possible side effects of OCREVUS.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

For more information, go to www.OCREVUS.com or call 1-844-627-3887.

For additional safety information, please see the full Prescribing Information and Medication Guide.

 

The OCREVUS Prepaid Mastercard® is issued by Comerica Bank pursuant to license by Mastercard International. No cash or ATM access. The card can be used only to purchase prescriptions at participating merchant locations where Debit Mastercard is accepted.