*For illustration purposes only, not a valid card
This offer is not transferrable and may not be combined with any other rebate/coupon, free trial, or similar offer. No substitutions are permitted.
The Repatha One-Month Free Trial Card is only valid for:
Repatha one (1) month free trial offer is limited to one-time one month supply and may only be used once per patient per lifetime. The Free Trial Card may be redeemed for either the once monthly or every two-week dose of Repatha, but may only be redeemed for a one (1) month supply of Repatha. The Free Trial Card may be redeemed at either hospital outpatient pharmacies or retail community pharmacies. No purchase required. This free trial offer is not health insurance. Void where prohibited by law.
Patients may not count the 1-month Free Trial of REPATHA as an expense incurred for purposes of determining out-of-pocket costs for any plan, including true out-of-pocket costs, ("TrOOP"), for purposes of calculating the out-of-pocket threshold for Medicare Part D plans. Offer not valid if reproduced or submitted to any payer or additional pharmacy. It is illegal for any person to sell, purchase, or trade, or offer to sell, purchase, or trade, or to counterfeit the Free Trial card. Only valid in the United States and Puerto Rico; this offer is void where restricted or prohibited by law. This card is the property of Amgen Inc. and must be returned or destroyed upon request. Amgen Inc. reserves the right to rescind, revoke, or amend offer without notice. Restrictions may apply. Offer subject to change or discontinuation without notice. This is not health insurance. This Free Trial card expires on 12/31/2022.
By redeeming this Free Trial offer, you acknowledge and certify that you have read and understood the terms and conditions, that you have not previously filled a prescription for Repatha, and that you have not and will not submit any claim(s) to any public or private third-party payer or any federal or state health care program for reimbursement.
BY USING THIS CARD, YOU AND YOUR PHARMACIST UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS AND CONDITIONS OF USE.
Submit the claim to Change Healthcare and use the Repatha Free Trial card as the primary insurance. No prescription claim is submitted to any third-party payer. Pharmacy reimbursement will be received through Change Healthcare. The patient will be able to receive their prescription at no cost. Offer is subject to a cap of wholesale acquisition cost plus usual and customary pharmacy charges.
The card can be used by any patient regardless of insurance status. Patient must be a resident of the United States or Puerto Rico, be 18 years or older, and have a valid one-month prescription for Repatha from a licensed healthcare professional. The card will work for either the once monthly or every two-week dose for Repatha with the following NDCs: 72511-0750-01, 72511-0760-02, or 72511-0770-01.
PLEASE NOTE: Every pharmacy has different systems and procedures. For any questions, the pharmacist or pharmacy tech can call 844-REPATHA, option “pharmacist” for processing assistance.
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.