Tarceva Co-Pay Card Program

We are committed to ensuring that all eligible patients have access to the therapies they need. That is why we created the Tarceva Co-Pay Card Program, a program that gives eligible patients help with their monthly insurance co-payments for Tarceva.

• If eligible, this program can reduce your monthly co-pays for up to one year, up to $4,000.
• For patients with commercial insurance and co-pays over $100 per month.
• Quick and simple program qualification and activation.

Eligibility - Can I use this program?

Please respond to the following statements to see if you are eligible for the Tarceva Co-Pay Card Program

	Yes	No
I am covered by commercial insurance. To answer "yes," you must not be covered by a government-funded healthcare program (such as Medicare Part D, Medicaid Medigap, VA, DoD, and Tricare [or any other federal- or state-funded benefit programs]) or already receiving benefits from the Genentech Access to Care Foundation.
My insurance co-pay for Tarceva is over $100
My annual household income is $100,000 or less
I am age 18 years or older
I currently live in either Puerto Rico or the United States, but not in Massachusetts. Massachusetts state law does not allow programs like this.

You are eligible if you answered "Yes" to all of the above.
Please speak with your Healthcare Provider for more information.

Answers to your questions

Am I eligible for the program?

You qualify for the Tarceva Co-Pay Card Program if you are covered by commercial insurance (non-governmental), your insurance co-pay is over $100, your annual household income is $100,000 or less, and you are age 18 years or older.

There are legal limits regarding who may participate in programs like this. You are not eligible if you are uninsured, covered by a government-funded healthcare program (eg, Medicare Part D, Medicaid Medigap, VA, DoD, or Tricare), currently residing in Massachusetts, or currently participating in the Genentech Access to Care Foundation.

How does the program work?

We have made it as easy as possible for you to get the support you need from the Tarceva Co-Pay Card Program. You can activate the card by answering some questions by phone or on the Internet. Then, present this card to your pharmacist along with your prescription. If eligible, your co-pay amount will be reduced accordingly.

How much co-payment support will I receive if I am eligible for the program?

Program pays: Contributes 80% of total copay after the first $100.

Example: $500 co-pay: patient pays first $100; program pays 80% of remaining $400 (total patient cost = $180)

What If I am not eligible for the program?

We develop medicines for serious or life-threatening medical conditions and we believe they should be accessible to the patients who need them. At Tarceva Access Solutions, we are here to help find a way for you to get Tarceva, regardless of your ability to pay for it. If you have difficulty paying for co-pay for Tarceva, an Access Solutions specialist can refer you to an independent, nonprofit organization for financial assistance. Call us at 1-888-249-4918 weekdays, 6AM to 5PM PST or visit our Web site at www.TarcevaAccessSolutions.com for more information.

Indication and Usage for Lung Cancer Patients

Tarceva is prescribed for patients with advanced-stage non-small cell lung cancer (NSCLC) who have received at least one prior chemotherapy regimen.

Indication and Usage for Pancreatic Cancer Patients

Tarceva in combination with gemcitabine is prescribed for patients with advanced-stage pancreatic cancer who have not received previous chemotherapy.

Important Safety Information

In clinical studies, there were infrequent reports of lung injuries similar to Interstitial Lung Disease (ILD)-like events in patients taking Tarceva for the treatment of non-small cell lung cancer (NSCLC) or other advanced solid tumors. Reports of these ILD-like lung injuries have been serious and have included deaths in some patients.

Liver and/or kidney problems (including deaths) have been reported in some patients taking Tarceva. Let your doctor know if you have a history of liver or kidney disease.

Holes that formed in the stomach, small intestine, or large bowel (including deaths) have been reported in patients taking Tarceva.

Severe blistering skin reactions including cases similar to Stevens-Johnson syndrome (including deaths) have been reported in patients taking Tarceva.

Patients taking Tarceva plus gemcitabine were more likely to experience bleeding and clotting problems such as heart attack or stroke.

Eye irritation and damage to the cornea have been reported in patients taking Tarceva. Patients should tell their doctor about eye problems, including eye pain, that get worse.

Tarceva may cause harm to an unborn baby or may cause possible risk of pregnancy loss. Women should avoid becoming pregnant and avoid breastfeeding while taking Tarceva.

Call your doctor right away if you have these signs or symptoms:

• New or worsening skin rash
• Serious or ongoing diarrhea, nausea, loss of appetite, vomiting, or stomach pain
• New or worsening shortness of breath or cough
• Fever
• Eye irritation

If you smoke, you should stop smoking while taking Tarceva, as it may affect how well Tarceva works for you. If you continue to smoke you should speak to your doctor before taking Tarceva.

Let your doctor know if you are taking other prescription or over-the-counter drugs or herbal supplements before you start taking Tarceva. While taking Tarceva, do not start taking any new drugs or herbal supplements before talking to your doctor. Do not eat grapefruit or drink grapefruit juice while taking Tarceva. Tarceva may also affect other medications you are taking.

Common side effects of Tarceva

Rash and diarrhea were the most common side effects associated with Tarceva in the NSCLC clinical study. You may also have other changes in your skin.

Fatigue, rash, nausea, loss of appetite, and diarrhea were the most common side effects associated with Tarceva plus gemcitabine therapy in the pancreatic cancer clinical study.

Always let your doctor or nurse know if you experience any side effects. Ask your doctor or nurse for the best way to handle drug-related side effects.

Tarceva is not right for everyone. Ask your doctor if once-daily Tarceva is right for you.

• Please see the Tarceva full prescribing information for complete safety information.

Terms & Conditions

Patients must present their card to the pharmacist along with their prescription to participate in this program. Use of the card does not obligate anyone to use or continue using any specific product or provider. If you have any questions regarding your eligibility or benefits or if you wish to discontinue your participation, call the Tarceva Co-Pay Card Program at 1-866-827-0612 (8:00AM - 8:00PM EST, Monday-Friday). You may receive additional program information about the Tarceva Co-Pay Card Program at 1-866-827-0612 (8:00AM - 8:00PM EST, Monday-Friday).

No person or entity may seek reimbursement from any third-party payer for any amount provided using the card program. Genentech USA, Inc., and OSI Pharmaceuticals, Inc., reserve the right to deny payment under the card to anyone deemed ineligible in accordance with the stated program criteria.