Tarceva Co-Pay Card Program

How does the program work?

Your practice gives eligible patients a brochure with an enclosed Tarceva Co-Pay Card at the time the prescription is written.
Eligible patients can then activate the card by phone or on the Internet before the prescription is filled.
The patient presents the activated card, along with their prescription, to the pharmacist and their co-pay amount will be reduced accordingly.

Who is eligible?

Eligible	Not Eligible
Covered by commercial insurance (non-governmental) AND	Participating in Medicare D, Medicaid Medigap, VA, DoD, and Tricare (or any other federal- or state-funded benefit programs) OR
Co-pay for Tarceva over $100 AND	Uninsured OR
Live in Puerto Rico or the United States AND	Currently residing in Massachusetts OR
Annual household income of $100,000 or less AND	Currently participating in the Genentech Access to Care Foundation
Age 18 years or older

How much does the program cover if my patient is eligible?		How do I explain to patients how this program works?
Patient responsibility	The first $100 per month of their Tarceva co-pay, plus any additional amount not covered by the program.	Eligibility	Be sure to highlight the need for commercial insurance with a co-pay of over $100.
Program pays	No monthly limit; program pays 80% of remaining copay after the first $100.	Program limits	Program pays up to 80% of the remaining copay after the first $100, up to $4000 per year. Patients must pay first $100 per month, plus amount not covered by program.
Program limit	Up to $4000 in Tarceva co-pay support, which must be used within 1 year after patient activates their card.	Getting started	Patient activates card, then presents the card, along with their prescription, to the pharmacist.

Where do I get Tarceva Co-Pay Cards?
Please speak with your Tarceva Sales Representative.

What about my Tarceva patients who are not eligible for this 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 to your patients, regardless of their ability to pay for it. If your patients have difficulty paying their co-pay for Tarceva, an Access Solutions specialist can refer them to an independent, nonprofit organization for financial assistance. Call us at 1-888-249-4918 weekdays, 6 AM to 5 PM PST or visit our Web site at www.TarcevaAccessSolutions.com for more information.

Indication and Usage

Tarceva monotherapy is indicated for the treatment of patients with locally advanced or metastatic non-small cell lung cancer after failure of at least one prior chemotherapy regimen.

Results from two, multicenter, placebo-controlled, randomized, Phase III trials conducted in first-line patients with locally advanced or metastatic NSCLC showed no clinical benefit with the concurrent administration of Tarceva with platinum-based chemotherapy [carboplatin and paclitaxel or gemcitabine and cisplatin] and its use is not recommended in that setting.

Indication and Usage

Tarceva in combination with gemcitabine is indicated for the first-line treatment of patients with locally advanced, unresectable or metastatic pancreatic cancer.

Important Safety Information

There have been infrequent reports of serious Interstitial Lung Disease (ILD)-like events, including fatalities, in patients receiving Tarceva for treatment of NSCLC, pancreatic cancer or other advanced solid tumors. In the event of an acute onset of new or progressive, unexplained pulmonary symptoms such as dyspnea, cough and fever, Tarceva therapy should be interrupted pending diagnostic evaluation. If ILD is diagnosed, Tarceva should be discontinued and appropriate treatment instituted as needed.

Cases of hepatic failure, hepatorenal syndrome, acute renal failure (all including fatalities), and renal insufficiency have been reported during use of Tarceva. Treatment with Tarceva should be used with extra caution in patients with total bilirubin > 3 x ULN. Tarceva dosing should be interrupted or discontinued if changes in liver function are severe. Patients should be closely monitored during therapy with Tarceva.

Gastrointestinal perforation (including fatalities) has been reported in patients receiving Tarceva. Permanently discontinue Tarceva in patients who develop gastrointestinal perforation.

Bullous, blistering and exfoliative skin conditions have been reported including cases suggestive of Stevens-Johnson syndrome/toxic epidermal necrolysis, which in some cases were fatal. Interrupt or discontinue Tarceva treatment if the patient develops severe bullous, blistering or exfoliating conditions.

In the pancreatic cancer trial, other serious adverse reactions associated with Tarceva plus gemcitabine and which may have included fatalities, were myocardial infarction/ischemia, cerebrovascular accident and microangiopathic hemolytic anemia with thrombocytopenia.

Corneal perforation and ulceration have been reported during use of Tarceva. Interrupt or discontinue Tarceva therapy if patients present with acute/worsening ocular disorders such as eye pain.

When receiving Tarceva therapy, women should be advised against becoming pregnant or breastfeeding. Tarceva is pregnancy category D.

The most common adverse reactions in patients with NSCLC receiving Tarceva monotherapy 150 mg were mild to moderate rash and diarrhea. Severe rash and diarrhea (9% & 6% NCI-CTC Grades 3-4, respectively) were reported. Rash and diarrhea each resulted in dose reductions (6% and 1%, respectively) and discontinuation in 1% of Tarceva-treated patients during the single-agent Phase III trial.

The most common adverse reactions in patients with pancreatic cancer receiving Tarceva 100 mg plus gemcitabine were fatigue, rash, nausea, anorexia and diarrhea. Severe rash and diarrhea (5% and 5% NCI-CTC Grades 3-4, respectively) were reported. Rash and diarrhea each resulted in dose reductions in 2% of patients, and discontinuation in up to 1% of patients receiving Tarceva plus gemcitabine.

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.

Please Note

As a healthcare provider, you may be obligated under your contracts with payers to disclose acceptance of funds provided through the Tarceva Co-Pay Card Program as payment for the products dispensed to your patient.
You may not advertise or otherwise use the Tarceva Co-Pay Card Program as a means of promoting your services or Genentech USA, Inc., and OSI Pharmaceuticals, Inc., products to patients.
No person or entity may seek reimbursement from any third-party payer for any amount provided using the card program.
This program supports patients who are being treated with Tarceva for its approved uses.
Genentech USA, Inc., and OSI Pharmaceuticals, Inc., reserve the right to deny payment under the Tarceva Co-Pay Card to anyone deemed ineligible in accordance with the stated program criteria.