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actemra patient assistance program application

by Eleonore Schroeder Published 2 years ago Updated 1 year ago
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What is the Actemra co-pay program?

The ACTEMRA Co-pay Program helps eligible commercially insured patients pay $5 per drug co-pay. † The program covers the rest up to $15,000 of co-pay assistance annually. This program helps pay for drug costs described as "out-of-pocket," "co-pay," "co-insurance" or "uncovered expense" for ACTEMRA only.

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 much can I expect to be paid 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. 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.

How do I get my Actemra without insurance coverage?

ACTEMRA Access Solutions works with your doctor, health insurance company and specialty pharmacy to help you get your ACTEMRA Do not have insurance coverage or your insurance doesn't cover enough of the cost of your ACTEMRA: Genentech Patient Foundation The Genentech Patient Foundation gives you your ACTEMRA for free if you're eligible*

What is ACTEMRA Access Solutions?

Who provides Genentech medicine?

Does ACTEMRA have a copay card?

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How do I get ACTEMRA?

The Genentech Patient Foundation gives eligible patients their ACTEMRA free of charge. For more information, call a Foundation Specialist at (888) 941-3331 or visit GenentechPatientFoundation.com. *You and your doctor are responsible for completing and submitting all required paperwork to your health insurance plan.

What is the cost of ACTEMRA?

Actemra (tocilizumab) is a member of the interleukin inhibitors drug class and is commonly used for COVID-19, Cytokine Release Syndrome, Giant Cell Arteritis, and others....Intravenous Solution.QuantityPer unitPrice10 milliliters$130.24$1,302.4220 milliliters$129.77$2,595.331 more row

Is ACTEMRA weight based?

Dosage for polyarticular juvenile idiopathic arthritis For polyarticular juvenile idiopathic arthritis (PJIA), Actemra may be given as an IV infusion or a subcutaneous injection. For this condition, your Actemra dosage is based on your body weight in kilograms (kg).

Should I take ACTEMRA?

You should not take any prescription drug, including Actemra, unless your doctor recommends it. For information about prevention and treatment, as well as expert advice, at our COVID-19 hub.

Does Medicare pay for ACTEMRA infusions?

Do Medicare prescription drug plans cover Actemra? No. In general, Medicare prescription drug plans (Part D) do not cover this drug.

What can I use instead of ACTEMRA?

Are Orencia and Actemra the Same Thing? Orencia (abatacept) and Actemra (tocilizumab) are used to treat the symptoms of rheumatoid arthritis. Orencia is also used to treat arthritis in children who are at least 6 years old.

Is ACTEMRA a high risk medication?

Actemra has a boxed warning for risk of serious infections, including tuberculosis (TB). A boxed warning is the most serious warning from the FDA. Some infections from Actemra may be serious enough to cause you to stay in the hospital. In rare cases, infections from Actemra can be fatal.

How do you feel after ACTEMRA infusion?

The most common Actemra (tocilizumab) side effects include runny or stuffy nose, sore throat, sinus infection, headache, high blood pressure and injection site reactions.

Is ACTEMRA a hazardous drug?

WARNING: RISK OF SERIOUS INFECTIONS Patients treated with ACTEMRA are at increased risk for developing serious infections that may lead to hospitalization or death [see Warnings and Precautions (5.

How long should you take ACTEMRA?

The recommended dose of ACTEMRA intravenous (IV) infusions for GCAEvery 4 weeks, you will receive a 60-minute-long IV infusion in combination with a tapering steroid treatment.The dose of ACTEMRA IV you receive will be based on your weight.ACTEMRA IV can be used alone after steroids have been stopped.

Can ACTEMRA cause memory loss?

In addition to the more serious Actemra symptoms, some of those taking the drug have claimed to have memory lapses, brain fog, mental sluggishness, small strokes, an increase in cholesterol levels, hair loss, tremors and the heart-rhythm disorder tachycardia after taking Actemra.

Does ACTEMRA cause fatigue?

Your healthcare provider may tell you to stop taking ACTEMRA if you develop new or worsening liver problems during treatment with ACTEMRA. Tell your healthcare provider right away if you have any of the following symptoms: feeling tired (fatigue) lack of appetite for several days or longer (anorexia)

Is there a generic for ACTEMRA?

The agency would not say if a Sentinel assessment of Actemra, also known by the generic name tocilizumab, has ever been initiated.

How quickly does ACTEMRA work?

ACTEMRA IV infusions, taken without methotrexate, started to work in as little as 2 weeks in some patients. Individual results may vary.

How often do you inject ACTEMRA?

ACTEMRA can be taken in different ways for polyarticular juvenile idiopathic arthritis (PJIA) symptoms. Intravenous (IV) infusion: This medicine is a liquid solution placed into a vein with a needle. It is given at a doctor's office or an infusion center every 4 weeks.

What are the side effects of ACTEMRA?

Common side effects of Actemra include:runny or stuffy nose,sinus pain,sore throat,headache,dizziness,itching,mild stomach cramps, or.urinary tract infection (UTI).

Apply For Help - Genentech

Step 1: Complete the online Patient Consent Form, which is available in English and Spanish: Patient Consent Form | Formulario de Consentimiento del Paciente. Step 2: Once you have completed the Patient Consent form, you can inform your doctor's office and let them know that you are applying for assistance from the Genentech Patient Foundation. Your doctor will have to complete another form ...

The Genentech Patient Foundation gives free medicine to people who are

Genentech Patient Foundation INSTRUCTIONS FOR ENROLLMENT How to apply 1. Patient fills out and signs page 3. 2. Prescriber fills out and signs page 4. 3. Completed application is faxed to (833) 999-4363. What to expect after applying?

GenentechPatientFoundation.com Prescriber Foundation Form Genentech ...

Page 2 of 2 *Please check one (refer to page 1 for details on each type): Uninsured Insured but lacks coverage Insured with coverage but medicine is unaffordable By signing below, I am agreeing to the following: (A) The Genentech medicine listed above is medically necessary for this patient. (B) I have received authorization to release the information ...

Genentech: Genentech Patient Foundation

En Español. Genentech Patient Foundation. Living with a serious illness can come with many challenges. Getting Genentech medicines shouldn’t be one of them.

Patient Assistance Application for HUMIRA (adalimumab) - RxHope

©2015 AbbVie Patient Assistance Foundation 15A-H-APP-1A January 2015 Printed in U.S.A. THIS PAGE TO BE COMPLETED BY PATIENT Patient Assistance Application for HUMIRA® (adalimumab) The AbbVie Patient Assistance Foundation provides HUMIRA at no cost to individuals who meet specific program eligibility criteria

Forms and Documents - genentech-access

Download, view or print ACTEMRA Access Solutions enrollment forms and other important documents. Submit enrollment forms online. Find sample letters of medical necessity and sample appeal letters.

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.

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.

Can you die from actherma?

Serious allergic reactions, including death, can happen with ACTEMRA. These reactions can happen with any infusion or injection of ACTEMRA, even if they did not occur with an earlier infusion or injection. Tell your healthcare provider before your next dose if you had hives, rash or flushing after your injection.

Can you get multiple sclerosis from actrea?

While rare, Multiple Sclerosis has been diagnosed in people who take ACTEM RA. It is not known what effect ACTEMRA may have on some nervous system disorders.

Does actuma increase cancer risk?

ACTEMRA may increase your risk of certain cancers by changing the way your immune system works .

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.

Where to report side effects of Actemra?

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.

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 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 is the rate of infection in actrea IV?

The rate of infections in the ACTEMRA-IV all-exposure population was 163.7 per 100 patient-years. The most common events observed were nasopharyngitis and upper respiratory tract infections. The rate of serious infections was numerically higher in patients weighing less than 30 kg treated with 10 mg/kg ACTEMRA-IV (12.2 per 100 patient-years) compared to patients weighing at or above 30 kg, treated with 8 mg/kg ACTEMRA-IV (4.0 per 100 patient-years). The incidence of infections leading to dose interruptions was also numerically higher in patients weighing less than 30 kg treated with 10 mg/kg ACTEMRA-IV (21%) compared to patients weighing at or above 30 kg, treated with 8 mg/kg ACTEMRA-IV (8%).

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)

Who should not take ACTEMRA?

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

Can you take an ice pack with an ACTEMRA SC?

You are eligible to receive a free Travel Pack and sharps container (optional) The Travel Pack will help you travel with your ACTEMRA SC. It includes an ice pack and a TSA card to help you bring your ACTEMRA through the airport. The sharps container will allow you to safely dispose of your ACTEMRA injection devices.

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.

Can you die from actherma?

Serious allergic reactions, including death, can happen with ACTEMRA. These reactions can happen with any infusion or injection of ACTEMRA, even if they did not occur with an earlier infusion or injection. Tell your healthcare provider before your next dose if you had hives, rash or flushing after your injection.

Can you get multiple sclerosis from actrea?

While rare, Multiple Sclerosis has been diagnosed in people who take ACTEM RA. It is not known what effect ACTEMRA may have on some nervous system disorders.

What is Genentech Patient Foundation?

The Genentech Patient Foundation gives free Genentech medicine to people who don't have insurance or who have financial concerns and meet eligibility criteria. Two forms are needed to enroll in the Genentech Patient Foundation:

Is Actemra a RSVP?

ACTEMRA ® (tocilizumab) patients enrolled in ACTEMRA Access Solutions are automatically enrolled in RSVP. Use this form to opt out of this program.

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:

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.

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 to do if you don't have insurance for Genentech?

If you do not have insurance, or if your insurance does not cover your Genentech medicine, you must meet a different set of income requirements. To find out if you are eligible for any of our programs, please use the tool below or call 1-800-ACTEMRA (1-800-228-3672) to talk with a specialist.

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.

Should you test for TB before taking ACTEMRA?

Your healthcare provider should test you for TB before starting and during treatment with ACTEMRA. Before starting ACTEMRA, tell your healthcare provider if you have: an infection, think you may have an infection, are being treated for an infection, or get a lot of infections that return.

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:

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 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.

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.

How to contact Genentech patient support?

The Genentech Patient Resource Center can help answer questions and connect you to an appropriate Genentech patient support service. Call 1-800-ACTE MRA (1-800-228-3672) with questions or to get started. *If you have health insurance, you must have already tried other types of financial assistance.

Should you test for TB before taking ACTEMRA?

Your healthcare provider should test you for TB before starting and during treatment with ACTEMRA. Before starting ACTEMRA, tell your healthcare provider if you have: an infection, think you may have an infection, are being treated for an infection, or get a lot of infections that return.

Can you submit a prescription electronically?

Electronic prescriptions can be submitted through an e-prescribing software or an electronic medical record that has been certified by Surescripts.

Do you need to complete a patient consent form?

Both forms are required. No action can be taken until a completed Patient Consent Form and Prescriber Service Form have been received.

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.†

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.*

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.*

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