Approved Use

Repatha® is an injectable prescription medicine used:

  • in adults with cardiovascular disease to reduce the risk of heart attack, stroke, and certain types of heart surgery. READ MORE
  • along with diet alone or together with other cholesterol-lowering medicines in adults with high blood cholesterol levels called primary hyperlipidemia (including a type of high cholesterol called heterozygous familial hypercholesterolemia [HeFH]) to reduce low-density lipoprotein (LDL) or bad cholesterol.
For adults with heart disease
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Get Helpful Resources With Amgen® SupportPlus

Whether you’re taking Repatha® or considering asking your doctor about a prescription, Amgen provides helpful resources to support you on your path to lowering high bad cholesterol (LDL-C). For Repatha® patients, Amgen SupportPlus offers additional support including the Co-Pay Card for eligible commercially insured patients.

Do you have a Repatha® prescription?

That's okay! By signing up, you’ll receive emails with important information about Repatha® to help you have a more productive conversation with your doctor.

Get Helpful Resources With Amgen® SupportPlus

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Program Enrollment – Patient Information

Let us know if either of the following applies to you so we can personalize the information you receive from us:

Have you ever had a heart attack or stroke?

Have you ever been diagnosed with type 2 diabetes?

Amgen’s Patient Authorization

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Uses and Disclosure of Personal Information

I authorize Amgen and its contractors and business partners (“Amgen”) to use and/or disclose my personal information, including my personal health information, for the following purposes only:

To operate, administer, enroll me in, and/or continue my participation in Amgen’s Repatha® information program and related activities; to provide me with informational and promotional materials relating to Amgen products and services and/or my condition or treatment; and/or to improve, develop, and evaluate products, services, materials, and programs related to my condition or treatment.

I understand that the operation and administration of certain services and/or programs may require that Amgen contact me by mail and/or email. I understand and consent to Amgen contacting me using the contact information provided in this form to enroll me in, operate, and administer the Repatha® information program.

I further understand that the Repatha® information program and additional informational and marketing communications related to my condition and treatment are optional and free services. I do not have to sign this authorization, and this authorization in no way affects my right to obtain any medications. To obtain a copy of this authorization or to cancel at any time, I can contact Amgen by calling 1-844-REPATHA (1-844-737-2842) or by writing to Amgen, PO Box 781046, Indianapolis, IN 46278-8046. The Amgen Privacy Statement can be found at http://www.amgen.com/privacystatement.

By checking the “I Agree” box, I am electronically indicating that I have read and understood Amgen’s Patient Authorization (above in its full text), that I am legally authorized to consent, and that I am providing my consent as the patient or the patient’s legal guardian for Amgen and its contractors and business partners to use and share the personal information I provide for the purposes described within the Patient Authorization. By exiting the page, my enrollment will be discontinued.

OPTIONAL: Amgen may contact me using the contact information provided in this form for participation in market research activities associated with Amgen’s products, services, and/or my condition or treatment.

Which Amgen® SupportPlus resources would you like to sign up for?

*Amgen® Nurse Partners are only available to patients that are prescribed certain Amgen products. They are not part of your patient’s treatment team and do not provide medical advice, nursing, or case management services. Amgen Nurse Partners will not inject patients with Amgen medications. Patients should always consult their healthcare provider regarding medical decisions or treatment concerns.

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Program Enrollment – Patient Information

Let us know if either of the following applies to you so we can personalize the information you receive from us:

Before starting Repatha®, did you ever have a heart attack or stroke?

Before starting Repatha®, have you ever been diagnosed with type 2 diabetes?

Healthcare Representative (Complete, if applicable)

I am a healthcare representative assisting a patient with enrollment.

Amgen Patient Authorization

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Uses and Disclosure of Personal Information

I authorize Amgen and its contractors and business partners (“Amgen”) to use and/or disclose my personal information, including my personal health information, for the following purposes only:

  • To operate, administer, enroll me in, and/or continue my participation in the Amgen® SupportPlus Co-Pay Program or any other Amgen-affiliated patient support services and activities related to my condition or treatment (for example, Co-Pay card programs, reimbursement assistance programs, drug coverage verification, nurse educator services, adherence program, and disease management support);
  • To contact, with my permission, my doctor and the rest of my health care team and share with them my health information that may be useful for my care;
  • To provide me with informational and promotional materials relating to Amgen products and services, and/or my condition or treatment; and/or
  • To improve, develop, and evaluate products, services, materials, and programs related to my condition or treatment.

In order for Amgen to provide me with the services and/or programs described above, Amgen needs to collect and use my personal information, including my personal health information. I understand that my personal health information may include any information, in electronic or physical form, in the possession of or derived from a health care provider, health care plan, pharmacy, pharmaceutical company, laboratory and/or their contractor (“health care provider”). This may include select information from or about my medical history and general health, my health care plan benefits, payment limits or restrictions covered by my health care plan policy, and/or my adherence to my treatment.

I authorize my health care providers to disclose my personal health information to Amgen, and between themselves, as necessary, but only for the purposes stated above in this Authorization. I understand that certain of my health care providers (such as pharmacies and specialty pharmacies) may receive remuneration from Amgen in exchange for disclosing my personal health information and/or for using my information to contact me with communications about Amgen products which have been prescribed to me (for example medication reminder programs) and other patient support services.

Expiration, Right to Obtain a Copy, and Right to Cancel

I understand that by signing this form, I authorize my health care providers or others who might hold my health information to only release it to Amgen employees, as well as to its contractors and business partners, who are performing the services set forth in this Authorization. I also understand I am authorizing my personal information, including my personal health information, to be used for the purposes described above. I understand and agree that by signing below, I am authorizing those who rely on this Authorization to release my personal health information for the earlier of five (5) years or until my participation in the program ends through my cancellation, unless a shorter time period is required by state law.

I understand that I can obtain a copy of this Authorization or cancel this Authorization at any time by calling Amgen at 1-844-REPATHA (737-2842) or by writing to PO Box 1366, Morristown NJ, 07962. If I cancel my consent, I will no longer qualify for the services described. I also understand that if a health care provider is disclosing my personal health information to Amgen on an authorized on-going basis, my cancellation with Amgen will be effective with respect to any such health care providers as soon as they receive notice of my cancellation.

No Effect on Treatment

I understand I do not have to sign this Authorization and that my enrollment in any of the services and/or programs described above is entirely voluntary. I understand that Amgen, as well as health care providers, cannot require me, as a condition of having access to medications, prescription drugs, treatment or other care, to sign this Authorization. Federal Law (including HIPAA) requires a signed authorization in order for Amgen to collect this information from my health care providers. I understand I cannot participate in the listed services and/or programs without signing this Authorization or an equivalent authorization with my health care providers.

Information Received from Health Care Providers

I understand that once my personal health information has been disclosed to Amgen, federal privacy laws may no longer apply and protect it from further disclosure. Amgen agrees, however, to protect my personal health information by only using and disclosing it as stated in the Authorization or as otherwise allowed or required by law.

Authorization to Contact

I understand and consent to Amgen contacting me using the contact information provided in this form to enroll me in, operate, and administer Amgen patient support services and/or programs as described above other than promotional communications by telephone or SMS/text (for which I can separately opt-in). I understand that the operation and administration of certain of these services and/or programs may require that Amgen contact me by telephone or SMS/text.

By checking the “I Agree” box, I am electronically indicating that I have read and understood Amgen’s Patient Authorization (above in its full text), that I am legally authorized to consent, and that I am providing my consent as the patient or the patient’s legal guardian for Amgen and its contractors and business partners to use and share the personal information I provide for the purposes described within the Patient Authorization. By exiting the page my enrollment will be discontinued.

By checking the “I Agree” box, I am electronically indicating that I have read and understood Amgen’s Patient Authorization (above in its full text), that I am legally authorized to consent, and that I am providing my consent as the patient or the patient’s legal guardian for Amgen and its contractors and business partners to use and share the personal information I provide for the purposes described within the Patient Authorization. By exiting the page, my activation and enrollment into Amgen® SupportPlus will be discontinued.

OPTIONAL: Amgen may contact me using the contact information provided in this form for participation in market research activities associated with Amgen’s products, services, and/or my condition or treatment.

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What type of insurance do you use to pay for your Repatha® prescription?

Are you eligible for Medicare but receiving prescription drug coverage from a former employer, union, or welfare plan?

By checking this box, I agree that I have read, understand, and accept the Eligibility Information and Terms and Conditions of the Repatha® Co-Pay Card

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Would you like to receive courtesy injection reminders?

How often do you take Repatha®?

When would you like your first dose reminder?

Would you like to receive refill reminders?

When would you like your first refill reminder?

How often would you like to receive prescription refill reminders?

Congratulations—You Are Now Enrolled in Amgen® SupportPlus!

Congratulations—You Are Now Re-Enrolled in Amgen® SupportPlus!

USE YOUR REPATHA® (evolocumab) CO-PAY CARD TODAY TO PAY AS LITTLE AS $5 PER MONTH*

To use your Co-Pay Card, take these 3 simple steps:

Print your Co-Pay Card

Share your Co-Pay Card information with your pharmacist

Pick up your Repatha® prescription

Print

Congratulations—You Are Now Enrolled in Amgen® SupportPlus!

Congratulations—You Are Now Re-Enrolled in Amgen® SupportPlus!

Important Safety Information

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.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

APPROVED USE

What is Repatha®?

Repatha® is an injectable prescription medicine used:

  • in adults with cardiovascular disease to reduce the risk of heart attack, stroke, and certain types of heart surgery.
  • along with diet alone or together with other cholesterol-lowering medicines in adults with high blood cholesterol levels called primary hyperlipidemia (including a type of high cholesterol called heterozygous familial hypercholesterolemia [HeFH]) to reduce low density lipoprotein (LDL) or bad cholesterol.

Please see full Prescribing Information.