Repatha® (evolocumab) Co-Pay Card Terms and 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:
- The Repatha® Co-Pay Card is open to patients with commercial insurance, regardless of
financial need. The program 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. (See ELIGIBILITY section below.)
- With the Repatha® Co-Pay Card, a commercially insured patient who meets eligibility
criteria may pay as little as a $15 co-pay per month for their Repatha® monthly
out-of-pocket costs.Monthly out-of-pocket costs include co-payment, co-insurance, and deductible
out-of-pocket costs. Amgen will pay the remaining eligible out-of-pocket costs on behalf of the
patient up to a Maximum Monthly Benefit, a Maximum Annual Program Benefit and/or the Patient
TotalProgram Benefit. Patients are responsible for all amounts that exceed these limits. (See
PROGRAM DETAILS section below.)
- Offer is subject to change or discontinuation without notice.
- The Repatha® Co-Pay Card provides support up to the Maximum Monthly Benefit, the
Maximum Annual Program Benefit and/or Patient Total Program Benefit. If a patient's commercial
insurance plan imposes different or additional requirements on patients who receive
Repatha® Co-Pay Card benefits, Amgen has the right to modify or eliminate those benefits.
Whether you are eligible to receive the Maximum Monthly Benefit, Maximum Program Benefit or Patient
Total Program Benefit is determined by the type of plan coverage you have. Please ask your Amgen
SupportPlus Representative to help you understand eligibility for the Repatha® Co-pay
Card, and whether your particular insurance coverage is likely to result in your reaching the
Maximum Monthly Benefit, the Maximum Annual Program Benefit, or your Patient Total Program Benefit,
by calling 1-844-REPATHA (1-844-737-2842). (See PROGRAM BENEFITS section below.)
I.ELIGIBILITY
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.
II.PROGRAM BENEFITS
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.
III. PROGRAM DETAILS
With the Repatha® Co-Pay Card, a commercially insured patient who meets eligibility
criteria may pay as little as a $15 Co-pay per month for their Repatha® monthly
out-of-pocket costs.
- For all eligible patients, the Repatha® Co-Pay Card offers:
- A program benefit that covers the patient's eligible out-of-pocket prescription costs for
Repatha® (co-pay, deductible, or co-insurance) on behalf of the patient, up to a
Maximum Monthly Benefit and/or a Maximum Annual Program Benefit.
- Repatha® patients may pay $15 out of pocket at the first fill and at every refill, and
Amgen will pay on behalf of the patient the remaining eligible out-of-pocket prescription costs
(up to the Patient Total Program Benefit described below; Repatha® patients are
responsible for all amounts that exceed this limit).
- Maximum Monthly Benefit, Maximum Annual Program Benefit, and/or Patient Total Program Benefit
and Benefits May Change, End, or Vary without notice.
- The Maximum Annual Program Benefit must be applied to the Repatha® patient's
out-of-pocket costs (co-pay, deductible, or co-insurance).
- The Patient Total Program Benefit amounts are unilaterally determined by Amgen in its sole
discretion and will not exceed the Maximum Monthly Benefit or Maximum Annual Program Benefit. The
Patient Total Program Benefit may be less than the
Maximum Monthly Benefit or Maximum Annual Program Benefit, depending on the terms of a patient's
prescription drug plan, and may vary among individual patients
covered by different plans, based on factors determined solely by Amgen, to
ensure all programs funds are used for the benefit of the patient. Each patient is responsible for
costs above the Patient Total Program Benefit amounts. Please ask your Amgen SupportPlus
Representative to help you understand whether your particular insurance coverage is likely to result
in your reaching the Maximum Monthly Benefit, Maximum Annual Program Benefit or your Patient Total
Program Benefit amount by calling 1-844-REPATHA
(1-844-737-2842) and follow the prompts.
- Participating patients are solely responsible for updating Amgen with changes to their
prescription health insurance including, but not limited to, initiation of insurance provided by the
government, the addition of any coverage terms that do not apply Repatha® Co-Pay Card
benefits to reduce a patient's out-of-pocket costs, such as accumulator adjustment benefit design or
a co-pay maximization program. Participating patients are responsible for providing Amgen with
accurate information necessary to determine program eligibility. By accepting payments from Amgen
made on behalf of participating patients, participating PBMs and Plans likewise are responsible for
providing Amgen with accurate information regarding patient eligibility.
- Patients may use the card every time they fill their Repatha® prescription. Benefits
reset each calendar year. Re-enrollment in the program is required at regular intervals. Patients
may continue in the program as long as the patient re-enrolls as required by Amgen and continues to
meet all of the program's eligibility requirements during participation in the program. Patients can
enroll/re-enroll by calling 1-844-REPATHA (1-844-737-2842) or by going to Repatha.com/copay.
