REPATHA® CO-PAY CARD TERMS & CONDITIONS
SUMMARY OF TERMS AND CONDITIONS
It is important that every patient read and understand the full Repatha® (evolocumab) Co-pay Card Terms and
Conditions. The following summary is not a substitute for reviewing the Terms and Conditions in their entirety.
As further described below, in general:
Repatha® Co-Pay Card Full Terms & Conditions
Eligibility Criteria: Subject to program limitations and terms and conditions, the Repatha® Co-pay Card is open to patients who have a Repatha® prescription and who have commercial or private insurance, including plans available through state and federal healthcare exchanges. This program helps eligible patients cover out-of-pocket costs
related to Repatha®, up to program limits. There is no income requirement to participate in this program.
This offer is not valid for patients whose Repatha® prescription is paid for in whole or in part by Medicare, Medicaid,
or any other federal or state healthcare program. It is not valid for cash-paying patients or where prohibited by law. A
patient is considered cash-paying where the patient has no insurance coverage for Repatha® or where the patient
has commercial or private insurance but Amgen in its sole discretion determines the patient is effectively uninsured
because such coverage does not provide a material level of financial assistance for the cost of a Repatha®
prescription. This offer is only valid in the United States, Puerto Rico, and the US territories.
The Repatha® Co-pay Card helps provide out-of-pocket support to eligible patients for their Repatha® prescription
up to program limits. See PROGRAM DETAILS for full description.
The Repatha® Co-pay Card offer does not cover out-of-pocket costs for any patient whose selected coverage option
under their commercial insurance plan does not apply Repatha® Co-pay Card payments to satisfy the patient’s co-
payment, deductible, or co-insurance for Repatha®. Patients with these plan limitations are not eligible for the
Repatha® Co-pay Card but may be eligible for other needs-based assistance provided by Amgen. These programs are
often referred to as accumulator adjustment programs. If you believe your commercial insurance plan may have such limitations, please contact Amgen SupportPlus at 1-844-REPATHA (1-844-737-2842).
The Repatha® Co-pay Card may modify the benefit amount, unilaterally determined by Amgen in its sole discretion,
to satisfy the out-of-pocket cost-sharing requirement for any patient whose plan or plan agent (including, but not
limited to, a Pharmacy Benefit Manager (PBM)) requires enrollment in the Repatha® Co-pay Card as a condition of
the plan or PBM waiving some or all of an otherwise applicable patient out-of-pocket cost-sharing amount. These
programs are often referred to as co-pay maximizer programs. If you believe your commercial insurance plan may
have such limitations, please contact Amgen SupportPlus at 1-844-REPATHA (1-844-737-2842). Health plans and
Pharmacy Benefit Managers are prohibited from enrolling or assisting in the enrollment of patients in the Repatha®
Co-pay Card. The patient, or his/her legal representative, must personally enroll in the Repatha® Co-pay Card in
order to be eligible for program benefits.
If at any time a patient begins receiving prescription drug coverage under any federal, state or government
healthcare program (including but not limited to Medicare, Medicaid, TRICARE, Department of Defense, or Veteran
Affairs programs), the patient will no longer be able to use this card and they must contact Amgen SupportPlus at
1-844-REPATHA (1-844-737-2842) to stop their participation in this program.
Patients may not seek reimbursement for the value received from the Repatha® Co-pay Card from any third-party
payers, including a flexible spending account or healthcare savings account. Participating in this program means
that you are ensuring you comply with any required disclosure regarding your participation in the Repatha® Co-pay
Card of your insurance carrier or Pharmacy Benefit Manager. Restrictions may apply. Offer is subject to change or
discontinuation without notice. This is not health insurance.
With the Repatha® Co-pay Card, a commercially insured patient who meets eligibility criteria may pay as little as a
$5 Co-pay per month for their Repatha® monthly out-of-pocket costs.
Do not use Repatha® if you are allergic to evolocumab or to any of the ingredients in Repatha®.
Before you start using Repatha®, tell your healthcare provider about all your medical conditions, including if you are allergic to rubber or latex, are pregnant or plan to become pregnant, or are breastfeeding or plan to breastfeed. The needle covers on the single-dose prefilled syringes and the inside of the needle caps on the single-dose prefilled SureClick® autoinjectors contain dry natural rubber. The single-dose Pushtronex® system (on-body infusor with prefilled cartridge) is not made with natural rubber latex.
Tell your healthcare provider or pharmacist about any prescription and over-the-counter medicines, vitamins, or herbal supplements you take.
What are the possible side effects of Repatha®?
Repatha® can cause serious side effects including serious allergic reactions. Stop taking Repatha® and call your healthcare provider or seek emergency help right away if you have any of these symptoms: trouble breathing or swallowing, raised bumps (hives), rash or itching, swelling of the face, lips, tongue, throat or arms.
The most common side effects of Repatha® include: runny nose, sore throat, symptoms of the common cold, flu or flu-like symptoms, back pain, high blood sugar levels (diabetes) and redness, pain, or bruising at the injection site.
Tell your healthcare provider if you have any side effect that bothers you or that does not go away.
These are not all the possible side effects of Repatha®. Ask your healthcare provider or pharmacist for more information. Call your healthcare provider for medical advice about side effects.
What is Repatha®?
Repatha® is an injectable prescription medicine used:
Please see full Prescribing Information.