A single source - Celgene Patient Support · 2017. 8. 2. · a Please see full Terms and Conditions on page 8 of this brochure. bFinancial and medical eligibility requirements vary

A single source for access support

Celgene Patient Support® provides:

• A single Specialist assigned to help patients in your geographic area

• Assistance with understanding patient insurance coverage for Celgene medications

• Information about financial assistance for prescribed Celgene medications

There are 3 simple ways to enroll in Celgene Patient Support®

Enroll online at www.celgenepatientsupport.com

Call us at 1-800-931-8691, Monday – Thursday, 8 am – 7 pm ET, and Friday, 8 am – 6 pm ET (translation services available)

E-mail us at [email protected] or fax 1-800-822-2496

Gregg Celgene Patient Support® Specialist

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Financial assistance Depending on a patient’s insurance situation, there are programs and organizations that may help pay for the prescribed Celgene medication.

• Celgene Commercial Co-pay Program for eligible patients with commercial or private insurance (including healthcare exchanges)*

• Independent third-party organizations for patients who are unable to afford their medication (including patients with Medicare, Medicaid, or other government-sponsored insurance)†

• Celgene Patient Assistance Program (PAP) for qualified patients who are uninsured or underinsured‡

*Other eligibility requirements and restrictions apply. Please see full Terms and Conditions on page 8 of this brochure.†Financial and medical eligibility requirements vary by organization.‡Patients must meet specified financial and eligibility requirements to qualify for assistance.§Celgene cannot provide insurance advice or make insurance decisions.

Celgene Patient Support® provides patients with support in accessing the following Celgene products:

There are 3 simple ways to enroll in Celgene Patient Support®




For products listed above, please see accompanying full Prescribing Information, including Boxed WARNINGS where applicable.

REVLIMID, POMALYST, and THALOMID are only available through restricted distribution programs.

Your Specialist is committed to helping patients get their prescribed Celgene medications

Insurance-related assistance§

On behalf of the patient, our Specialists are available to assist with each of the following steps in the insurance approval process for prescribed Celgene medications:

• Initiating a benefits investigation • Assessing prior authorization or precertification requirements• Providing information about the appeals process• Educating patients about insurance coverage or other programs for which

they may qualify

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Helpful Celgene Patient Support® resources

Financial assistance

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Celgene Patient Support® website www.celgenepatientsupport.com

• Enroll online

• Meet your Specialist – find out who the Specialist is for your geographic area and how to contact him or her

• Get financial assistance information for prescribed Celgene medications

• Download forms and the enrollment application (forms available in both English and Spanish)

Celgene Patient Support® programs

You can connect with your Celgene Patient Support® Specialist in person or through a web conference. Call your Specialist at 1-800-931-8691 to set up a meeting.

Field Reimbursement Specialists

Your Field Reimbursement Specialist is a field-based extension of Celgene Patient Support® who can provide the following for prescribed Celgene medications:

• Coding and reimbursement education

• Assistance with understanding regional and local payer coverage policies

• Information about financial assistance options for patients

Call your Celgene Patient Support® Specialist at 1-800-931-8691 to learn more.

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* Other eligibility requirements and restrictions apply. Please see full Terms and Conditions on page 8 of this brochure. † Patients may be subject to a random audit to verify income. ‡ Financial and medical eligibility requirements vary by organization.

Celgene medication may be available at no cost to patients who meet insurance and financial criteria

Provides assistance to help patients meet co-pay/co-insurance costs

Reduces co-pay responsibility to $25 or less for the prescribed Celgene medication

Eligibility criteria for patients include*:

Gross annual household income of $100,000 or less†

Commercial or private insurance that does not cover the full cost of the prescribed Celgene medication

Residence in the United States or a US territory

Patients with government healthcare insurance (for example, Medicaid, Medicare, Medigap, TriCare) are not eligible

Celgene Patient Assistance Program (PAP)

For qualified patients who are uninsured or underinsured

Celgene Commercial Co-pay Program

For eligible patients with commercial or private insurance (including healthcare exchanges)

Financial assistance: Independent third-party organizations

For patients who are unable to afford their medication (including patients with Medicare, Medicaid, or other government-sponsored insurance)‡

Celgene Patient Support® can provide you with information about independent third-party organizations that may be able to help with the cost of:

Deductibles

Co-payments/co-insurance

Insurance premiums

Transportation assistance‡

Celgene Patient Support® can provide information about financial assistance for transportation costs to and from medical appointments.

Independent third-party organizations may be able to help patients with transportation costs, such as gasoline, parking, tolls, and taxi, bus, or train fare, to and from medical appointments.

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Financial assistance options are available for each insurance situation




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Celgene Commercial Co-pay Program Terms and Conditions

EligibilityPatients must meet the following criteria to enroll:• Covered by commercial or private insurance• Reside in the United States or a US territory• Not participating in a federal or state-funded healthcare program, including, but not limited to,

Medicare or Medicaid, Medigap, CHAMPUS, VA, DOD, or Tricare• Gross annual household income must not exceed $100,000

– Gross household income is the total income before income tax deductions from all people living in your household. Gross income refers not only to the salaries and benefits received, but also to receipts from any personal business, investments, dividends, and other income

Program Benefits• For Celgene oral hematology products, Celgene provides assistance to reduce the co-pay of eligible

patients to $25 per prescription with a maximum benefit of $10,000 per enrollment period• For Celgene IV products, the Program will cover the co-pay for each prescription of a Celgene product

up to a maximum of $10,000 per enrollment period• In order to receive the Program benefits for a Celgene IV product, patients or their providers must

submit an Explanation of Benefits (EOB) form• Patients are responsible for any costs that exceed the Program’s $10,000 maximum • The Program will not cover, and shall not be applied toward, the cost of any dosing procedure, any other

healthcare provider service or supply charges or other treatment costs, or any costs associated with a hospital stay

Program Timing• If eligible, patients will be enrolled from the date of enrollment through the end of the then current calendar year

Additional Terms and Conditions of the Celgene Commercial Co-pay Program• Patients, pharmacists, and healthcare providers must not seek reimbursement from health insurance or

any third party for any part of the benefit received by the patient through this Program. Patients must not seek reimbursement from any health savings, flexible spending, or other healthcare reimbursement accounts for the amount of assistance received from the Program

• Acceptance of this offer confirms that this offer is consistent with your insurance and that you will report the value of the co-pay assistance you receive, as may be required by your insurance provider

• Only valid in the United States and US territories; this offer is void where prohibited by law, taxed or restricted. Absent a change in Massachusetts law, effective July 1, 2019, Massachusetts residents will no longer be eligible to participate in this Program

• The Program benefits are nontransferable • Acceptance of this Program is not conditioned on any past, present, or future purchase, including

additional doses• The Program cannot be combined with any other coupon, rebate, voucher, free trial, or similar offer• The Program is not insurance• Celgene reserves the right to rescind, revoke, or amend this Program at any time without notice

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Our Specialists are committed to helping patients get their prescribed Celgene medicationsUse this table to understand the financial assistance available for each Celgene product.

Product Co-pay assistance PAP

Celgene Commercial Co-pay Programa

Financial assistance from

third-party organizationsb

Celgene Patient Assistance

Program (PAP) – For uninsured

and underinsuredc

$25 co-pay for eligible patients

Provide patients with information about independent third-party organizations

that provide financial support, including

co-pay assistance, for eligible patients who cannot afford their

medication.




REVLIMID, POMALYST, and THALOMID are only available through restricted distribution programs.For products listed above, please see accompanying full Prescribing Information, including Boxed WARNINGS where applicable.

Product Co-pay assistance PAP

Celgene Commercial Co-pay Programa

Financial assistance from

third-party organizationsb

Celgene Patient Assistance

Program (PAP) – For uninsured

and underinsuredc


Provide patients with information about independent third-party organizations

that provide financial support, including

co-pay assistance, for eligible patients who cannot afford their

medication.


Not available

a Please see full Terms and Conditions on page 8 of this brochure. bFinancial and medical eligibility requirements vary by organization. cPatients must meet specified financial and insurance eligibility criteria to qualify for assistance.

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KirstenCelgene Patient Support® Specialist

Insurance-related services

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Our team has experience supporting patients, having worked as nurses, pharmacists, social workers, and in other healthcare roles.

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Insurance-related assistance* Pharmacy fulfillment support

Benefits investigation

• Initiate a benefits investigation to determine co-payment and other out-of-pocket costs

• Assess prior authorization or precertification requirements

• Educate patients about insurance coverage or other programs for which they may qualify

Prior authorization/precertification assistance†

• Assist with the prior authorization or precertification process by providing the necessary forms for completion

• Follow up with the insurance provider to determine the outcome

Appeals assistance†

• Provide information about the appeals process after a denied prior authorization, precertification, and/or claim

• Supply a checklist of the required documentation for submission to the insurance company

• Submit the appeal to the insurance company at the request of the patient and follow up on the status until a decision is reached

On behalf of the patient, our Specialists are available to assist with each of the following steps in the insurance approval process for prescribed Celgene medications:

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Find a network pharmacy

Certain Celgene products are available exclusively through a select network of pharmacies due to restricted distribution programs. Our Celgene Patient Support® Specialists can provide information on which pharmacy is in-network with each patient’s insurer.

You can access the REMS Pharmacy Network List online at www.celgene.com/patients/rems-pharmacy-network.

* Celgene cannot provide insurance advice or make insurance decisions.† Celgene provides a facilitation service and will not provide any medical input into a prior authorization or an appeal.

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I am personally committed to helping patients get their Celgene medications as quickly as possible.

PeterCelgene Patient Support® Specialist

Fast Track for First Prescription® is available to help eligible patients receive their first prescription faster.

To be eligible, patients must:

• Have received their first prescription for a Celgene oral oncology product for an FDA-approved indication

• Have documented proof of insurance

• Be enrolled in a Celgene REMS program

To enroll your patients in the Fast Track program, please provide Celgene Patient Support® with the following information:

• Patient’s insurance information

• Prescription

• Patient’s Celgene REMS authorization number

Complete the online application and select the “Fast Track” option. You may also fax a completed application and prescription to 1-800-822-2496 and note “Fast Track” on the fax.

Call your Specialist at 1-800-931-8691, Monday – Thursday, 8 am – 7 pm ET, and Friday, 8 am – 6 pm ET (translation services available)

Online at www.celgenepatientsupport.com

Fax us at 1-800-822-2496

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Meet your Celgene Patient Support® Specialist

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ABRAXANE®, Celgene Patient Support®, Fast Track for First Prescription®, IDHIFA®, ISTODAX®, POMALYST®, REVLIMID®, THALOMID®, and VIDAZA® are registered trademarks of Celgene Corporation. Other trademarks are the property of their respective owners.

© 2017 Celgene Corporation 05/17 US-MBM160091(1)




Celgene Patient Support® provides patients with support in accessing the following Celgene products:

For products listed above, please see accompanying full Prescribing Information, including Boxed WARNINGS where applicable.

REVLIMID, POMALYST, and THALOMID are only available through restricted distribution programs.

Documents

A single source - Celgene Patient Support · 2017. 8. 2. · a Please see full Terms and Conditions on page 8 of this brochure. bFinancial and medical eligibility requirements vary