Patient-Helpdesk.com

actemra patient assistance form

by Prof. Lori Rice Published 1 year ago Updated 1 year ago
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How much does it cost to pay for Actemra?

†The final amount owed by patients may be as little as $5, but may vary depending on the patient's health insurance plan. Eligible commercially insured patients who are prescribed ACTEMRA for an FDA-approved use can receive up to $15,000 in assistance annually for drug costs.

What is the Actemra co-pay card program?

If eligible commercially insured patients need assistance with their out-of-pocket costs, ACTEMRA Access Solutions can refer them to the ACTEMRA Co-pay Card Program.* *Eligibility criteria apply. Not valid for patients using federal or state government programs to pay for their medications and or administration of their Genentech medication.

What is Actemra used to treat?

Important Safety Information & Indication. ACTEMRA 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).

How do I Opt Out of RSVP with Actemra?

ACTEMRA patients enrolled in ACTEMRA Access Solutions are automatically enrolled in RSVP. Use this form to opt out of this program. Use this cover sheet when faxing documents to ACTEMRA Access Solutions.

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What is ACTEMRA Access Solutions?

For eligible patients with commercial or public health insurance, ACTEMRA Access Solutions offers referrals to independent co-pay assistance foundations.†

Does ACTEMRA have a copay card?

ACTEMRA Access Solutions can refer eligible patients to the ACTEMRA Co-pay Card Program for help with the out-of-pocket costs associated with their Genentech medicine.*

Who provides Genentech medicine?

The Genentech Patient Foundation provides free Genentech medicine to people who don't have insurance coverage or who have financial concerns and to people who meet certain income criteria.*

Who should not take ACTEMRA?

Do not take ACTEMRA if you are allergic to tocilizumab, or any of the ingredients in ACTEMRA.

What is ACTEMRA used for?

ACTEMRA is used: To treat adults with moderately to severely active rheumatoid arthritis (RA) after at least one other medicine called a disease modifying antirheumatic drug (DMARD) has been used and did not work well. To treat adults with giant cell arteritis (GCA)

How to report side effects of Genentech?

Tell your healthcare provider if you have any side effects. You may report side effects to the FDA at 1-800-FDA-1088. You may also report side effects to Genentech at 1-888-835-2555.

How to contact Genentech about resources?

You can request resources by calling 1-800-ACTEMRA (1-800-228-3672). No purchase is necessary to join the program. By providing your information you agree to allow Genentech and its agents to collect the information provided and to be contacted by Genentech and its agents using this information in the future.

What are the symptoms of an infection?

Symptoms of an infection, with or without a fever, include sweating or chills; shortness of breath; warm, red or painful skin or sores on your body; feeling very tired; muscle aches; blood in phlegm; diarrhea or stomach pain; cough; weight loss; burning when you urinate or urinating more than normal

Is ACTEMRA a copay?

This ACTEMRA Co-pay Program is valid ONLY for patients with commercial insurance who have a valid prescription for a Food and Drug Administration (FDA)-approved indication of a Genentech medication. Patients using Medicare, Medicaid or any other federal or state government program to pay for their medications are not eligible.

What does it mean when you feel tired?

feeling tired (fatigue) lack of appetite for several days or longer (anorexia) yellowing of your skin or the whites of your eyes (jaundice) abdominal swelling and pain on the right side of the stomach-area. light colored stools. weakness. nausea and vomiting.

Who should not take ACTEMRA?

Do not take ACTEMRA if you are allergic to tocilizumab, or any of the ingredients in ACTEMRA.

How long after ACTEMRA can you check cholesterol?

Increase in blood cholesterol levels: your cholesterol levels should be checked 4 to 8 weeks after you start receiving ACTEMRA.

How to report side effects of Genentech?

Tell your healthcare provider if you have any side effects. You may report side effects to the FDA at 1-800-FDA-1088. You may also report side effects to Genentech at 1-888-835-2555.

What are the symptoms of an infection?

Symptoms of an infection, with or without a fever, include sweating or chills; shortness of breath; warm, red or painful skin or sores on your body; feeling very tired; muscle aches; blood in phlegm; diarrhea or stomach pain; cough; weight loss; burning when you urinate or urinating more than normal

Does actema cause TB?

ACTEMRA changes the way your immune system works. This can make you more likely to get infections or make any current infection worse. Some people have serious infections while taking ACTEMRA, including tuberculosis (TB), and infections caused by bacteria, fungi, or viruses that can spread throughout the body. Some people have died from these infections. Your healthcare provider should test you for TB before starting and during treatment with ACTEMRA.

Can you take actherma with diverticulitis?

If you have diverticulitis (inflammation in parts of the large intestine), talk to your healthcare provider before taking ACTEMRA. Some people taking ACTEMRA may develop a hole in the wall of their stomach or intestines (also known as a perforation). This happens most often in people who also take nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or methotrexate.

Where do fungal infections occur?

These parts include the Ohio and Mississippi River valleys and the Southwest

What should I tell my healthcare provider before receiving ACTEMRA?

ACTEMRA may not be right for you. Before receiving ACTEMRA, tell your healthcare provider if you:

How long after ACTEMRA can you check cholesterol?

Increase in blood cholesterol levels: your cholesterol levels should be checked 4 to 8 weeks after you start receiving ACTEMRA.

How to report side effects of Genentech?

You may report side effects to the FDA at 1-800-FDA-1088. You may also report side effects to Genentech at 1-888-835-2555. Please see full Prescribing Information and the Medication Guide, including Serious Side Effects, for more Important Safety Information.

What are the symptoms of an infection?

Symptoms of an infection, with or without a fever, include sweating or chills; shortness of breath; warm, red or painful skin or sores on your body; feeling very tired; muscle aches; blood in phlegm; diarrhea or stomach pain; cough; weight loss; burning when you urinate or urinating more than normal

Does actema cause TB?

ACTEMRA changes the way your immune system works. This can make you more likely to get infections or make any current infection worse. Some people have serious infections while taking ACTEMRA, including tuberculosis (TB), and infections caused by bacteria, fungi, or viruses that can spread throughout the body. Some people have died from these infections. Your healthcare provider should test you for TB before starting and during treatment with ACTEMRA.

What are the side effects of ACTEMRA?

These blood tests are to check for the following side effects of ACTEMRA: Low neutrophil count: neutrophils are white blood cells that help the body fight infection. Low platelet count: platelets are blood cells that help with clotting, which stops bleeding. Increase in liver function test levels.

What does it mean when you feel tired?

feeling tired (fatigue) lack of appetite for several days or longer (anorexia) yellowing of your skin or the whites of your eyes (jaundice) abdominal swelling and pain on the right side of the stomach-area. light colored stools. weakness. nausea and vomiting.

What should I tell my healthcare provider before receiving ACTEMRA?

ACTEMRA may not be right for you. Before receiving ACTEMRA, tell your healthcare provider if you:

How to report side effects of Genentech?

Tell your healthcare provider if you have any side effects. You may report side effects to the FDA at 1-800-FDA-1088. You may also report side effects to Genentech at 1-888-835-2555.

How long after ACTEMRA can you check cholesterol?

Increase in blood cholesterol levels: your cholesterol levels should be checked 4 to 8 weeks after you start receiving ACTEMRA.

What are the symptoms of an infection?

Symptoms of an infection, with or without a fever, include sweating or chills; shortness of breath; warm, red or painful skin or sores on your body; feeling very tired; muscle aches; blood in phlegm; diarrhea or stomach pain; cough; weight loss; burning when you urinate or urinating more than normal

Does actema cause TB?

ACTEMRA changes the way your immune system works. This can make you more likely to get infections or make any current infection worse. Some people have serious infections while taking ACTEMRA, including tuberculosis (TB), and infections caused by bacteria, fungi, or viruses that can spread throughout the body. Some people have died from these infections. Your healthcare provider should test you for TB before starting and during treatment with ACTEMRA.

Is ACTEMRA a copay?

This ACTEMRA Co-pay Program is valid ONLY for patients with commercial insurance who have a valid prescription for a Food and Drug Administration (FDA)-approved indication of a Genentech medication. Patients using Medicare, Medicaid or any other federal or state government program to pay for their medications are not eligible.

Can you take actherma with diverticulitis?

If you have diverticulitis (inflammation in parts of the large intestine), talk to your healthcare provider before taking ACTEMRA. Some people taking ACTEMRA may develop a hole in the wall of their stomach or intestines (also known as a perforation). This happens most often in people who also take nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or methotrexate.

What is ACTEMRA used for?

ACTEMRA 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). ACTEMRA is indicated for the treatment of giant cell arteritis (GCA) in adult patients.

How many ISRs are there in ACTEMRA SC?

During the 1-year study, a frequency of 28.8% (15/52) ISRs was observed in ACTEMRA-SC treated PJIA patients. These ISRs occurred in a greater proportion of patients at or above 30 kg (44.0%) compared with patients below 30 kg (14.8%). All ISRs were mild in severity and none of the ISRs required patient withdrawal from treatment or dose interruption.

What are the most common adverse reactions to methotrexate?

The most common serious adverse reactions were serious infections. The most common serious infections included pneumonia, urinary tract infection, cellulitis, herpes zoster, gastroenteritis, diverticulitis, sepsis and bacterial arthritis. In the ACTEMRA-IV monotherapy clinical study, the rate of serious infections was 3.6 per 100 patient-years in the ACTEMRA group and 1.5 per 100 patient-years in the methotrexate group. The rate of serious infections in the 4 mg/kg and 8 mg/kg ACTEMRA plus DMARD groups was 4.4 and 5.3 events per 100 patient-years, respectively, compared to 3.9 events per 100 patient-years in the placebo plus DMARD group.

How long does it take for ACTEMRA to show signs of liver damage?

Some of these cases have resulted in liver transplant or death. Time to onset for cases ranged from months to years after treatment initiation. Most cases presented with marked elevations of transaminases (> 5 times ULN), and some cases presented with signs or symptoms of liver dysfunction and only mildly elevated transaminases.

What are the most common ISRs in SJIA?

A total of 41.2% (21/51) SJIA patients experienced ISRs to ACTEMRA-SC. The most common ISRs were erythema, pruritus, pain, and swelling at the injection site. The majority of ISRs reported were Grade 1 events and all ISRs reported were non-serious and none required patient withdrawal from treatment or dose interruption.

What are the most common adverse events in ACTEMRA IV?

The most common adverse events (at least 5%) seen in ACTEMRA-IV treated patients in the 12-week controlled portion of the study were: upper respiratory tract infections, headache, nasopharyngitis, and diarrhea.

What are the most common events that occur during an infusion?

The most common events occurring during infusion were headache, nausea and hypotension, and occurring within 24 hours of infusion were dizziness and hypotension.

How to contact Genentech about Actemra?

Medicine Information Support. Ask about possible side effects and any other medical questions related to your prescribed Genentech medicine. Call us at (800) 821-8590, Monday-Friday, 5am-5pm PT. Chat with us using our live chat feature, Monday-Friday, 5am-5pm PT.

How to report side effects of Genentech?

You may report side effects to the FDA at 1-800-FDA-1088. You may also report side effects to Genentech at 1-888-835-2555. Please see full Prescribing Information and the Medication Guide, including Serious Side Effects, for more Important Safety Information.

What is DMARD used for?

To treat adults with moderately to severely active rheumatoid arthritis (RA) after at least one other medicine called a disease modifying antirheumatic drug (DMARD) has been used and did not work well. To treat people with active polyarticular juvenile idiopathic arthritis (PJIA) 2 years of age and older.

What is the phone number for Genentech?

Genentech Patient Resource Center. Our center dedicated to getting patients and caregivers to the right resources. Call us at (877) 436-3683 or (877) GENENTECH, Monday-Friday, 6am-5pm PT. Genentech Access Solutions. This service offers coverage support, patient assistance, and other useful information.

How old do you have to be to get PJIA?

To treat people with active polyarticular juvenile idiopathic arthritis (PJIA) 2 years of age and older

Can ACTEMRA cause TB?

Serious Infections. ACTEMRA changes the way your immune system works. This can make you more likely to get infections or make any current infection worse. Some people have died from these infections. Your healthcare provider should test you for TB before starting and during treatment with ACTEMRA.

Can ACTEMRA cause multiple sclerosis?

While rare, Multiple Sclerosis has been diagnosed in people who take ACTEMRA.

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