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Hi {PatientLastName},
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Your Enbrel Co‑Pay Card* is here!
Provide your specialty pharmacy with
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the information below to get ENBREL for as little as $0*
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Here’s how to get started:
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Call your specialty pharmacy and provide the following information:
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RxBIN: {RxBIN}
PCN: {PCN}
MEMBER ID: {MEMBERID}
GROUP: {Group}
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That’s it! Once the pharmacist has your co-pay card information, it will be
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automatically applied each time you fill your ENBREL prescription.
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With you along the way,
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—Your ENBREL Team
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Amgen® SupportPlus Co-Pay Card Terms & Conditions
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SUMMARY OF TERMS AND CONDITIONS
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It is important that every patient read and understand the full Amgen®
SupportPlus Co-Pay Card Terms and Conditions. The following summary is not a substitute for reviewing the
Terms and Conditions in their entirety. Please visit www.AmgenSupportPlus.com for full
Terms and Conditions.
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As further described below, in general:
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The Amgen SupportPlus Co-Pay Card is open to patients with commercial insurance that
covers an Amgen SupportPlus product, regardless of financial need. The program is not
valid for patients whose prescription for an Amgen SupportPlus product 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 in full
Terms & Conditions.)
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The Amgen SupportPlus Co-Pay Card may help lower your Amgen SupportPlus product
out-of-pocket medication costs. Out-of-pocket costs may include co-payment,
co-insurance, and deductible out-of-pocket costs. The Amgen SupportPlus Co-Pay Card
does not cover any other costs related to office visits or administration of the product. The
Amgen SupportPlus Co-Pay Card provides support up to the Maximum Program Benefit
or Patient Total Program Benefit. If a patient’s commercial insurance plan imposes
different or additional requirements on patients who receive Amgen SupportPlus Co-Pay
Card benefits, Amgen has the right to modify or eliminate those benefits. Whether you are
eligible to receive the 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 Amgen SupportPlus Co-Pay Card,
whether your particular insurance coverage is likely to result in your reaching the
Maximum Program Benefit or your Patient Total Program Benefit amount by calling
1-833-44AMGEN (1-833-442-6436). (See PROGRAM BENEFITS section in full Terms &
Conditions.)
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Amgen SupportPlus patient may pay as little as $0 out-of-pocket for each prescription fill,
dose or cycle of the Amgen SupportPlus product.
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Amgen will pay the remaining eligible out-of-pocket costs on behalf of the patient until the
Amgen payments have reached either the Maximum Program Benefit and/or the Patient
Total Program Benefit. Patients are responsible for all amounts that exceed this limit.
Please ask your Amgen SupportPlus Support Representative to help you understand
eligibility for the Amgen SupportPlus Co-Pay Card by calling 1-833-44AMGEN
(1-833-442-6436). (See PROGRAM DETAILS section in full Terms & Conditions.)
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I. ELIGIBILITY
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*Eligibility Criteria: Subject to program limitations and terms and conditions, the
Amgen SupportPlus Co-Pay Card is open to patients who have been prescribed an Amgen
SupportPlus product and who have commercial or private insurance that covers an Amgen
SupportPlus product, including state and federal plans commonly referred to as "healthcare
exchanges plans". This program helps eligible patients cover out-of-pocket medication
costs related to an Amgen SupportPlus product, up to program limits. The Amgen
SupportPlus Co-Pay Card does not cover any other costs related to office visits or
administration of an Amgen SupportPlus product. There is no income requirement to
participate in this program.
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This offer is not valid for patients whose prescription for an Amgen SupportPlus
product 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 an Amgen SupportPlus product 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 an Amgen SupportPlus product prescription. This
offer is only valid in the United States, Puerto Rico, and the US territories.
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II. PROGRAM BENEFITS
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The Amgen SupportPlus 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 Amgen SupportPlus 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 Support at 1-833-44AMGEN
(1-833-442-6436).
Health plans and Pharmacy Benefit Managers are prohibited from
enrolling or assisting in the enrollment of patients in the Amgen SupportPlus Co-Pay Card.
The patient, or his/her legal representative, must personally enroll in the Amgen
SupportPlus Co-Pay Card in order to be eligible for program benefits.
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If at any time a patient begins receiving coverage for medications 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 you must contact
Amgen SupportPlus at 1-833-44AMGEN
(1-833-442-6436)
(Monday through Friday, from 8:00 am to 8:00 pm ET) to stop your
participation in this program.
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Patients may not seek reimbursement for the value received from the Amgen SupportPlus
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 Amgen SupportPlus
Co-Pay Card of your insurance carrier or pharmacy benefit manager. Restrictions may
apply. Offer subject to change or discontinuation without notice.
This is not health
insurance.
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III. PROGRAM DETAILS
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For all eligible patients the Amgen SupportPlus Co-Pay Card offers:
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A program benefit that covers the patient’s eligible out-of-pocket medication costs for the
Amgen SupportPlus product (co-pay, deductible, or co-insurance) on behalf of the patient,
up to a Maximum Program Benefit determined by the program per calendar year. The
Amgen SupportPlus Co-Pay Card does not cover any other costs related to office visits or
administration of an Amgen SupportPlus product.
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Amgen SupportPlus patients may pay as little as $0 out-of-pocket for each prescription fill,
dose or cycle.
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Amgen will pay the remaining eligible out-of-pocket prescription costs on behalf of the
patient until the Amgen payments have reached either the Maximum Program Benefit
and/or the Patient Total Program Benefit. Patients are responsible for all amounts that
exceed this limit.
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Maximum Program Benefit, Patient Total Program Benefit, Benefits May Change, End
or Vary Without Notice:
The program provides up to a Maximum Program Benefit of
support to reduce a patient’s out-of-pocket medication costs that Amgen will provide per
patient for each calendar year, which must be applied to the Amgen SupportPlus patient’s
out-of-pocket costs (co-pay, deductible, or co-insurance and annual out-of-pocket
maximum). Patient Total Program Benefit amounts are unilaterally determined by Amgen
in its sole discretion and will not exceed the Maximum Program Benefit. The Patient Total
Program Benefit may be less than the Maximum Program Benefit, depending on the terms
of a patient’s 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 Support Representative to
help you understand whether your particular insurance coverage is likely to result in your
reaching the Maximum Program Benefit or your Patient Total Program Benefit amount by
calling 1-833-44AMGEN (1-833-442-6436). Participating patients are solely responsible for
updating Amgen with changes to their insurance including, but not limited to, initiation of
insurance provided by the government, the addition of any coverage terms that do not apply
Amgen SupportPlus 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.
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Patients may use the card every time they receive a prescription fill, dose or cycle of the
Amgen SupportPlus product, up to the Maximum Program Benefit or Patient Total Program
Benefit. Benefits reset each calendar year. Re-enrollment in the program is required at
regular intervals. Patients may continue in the program as long as 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/reenroll by calling 1-833-44AMGEN
(1-833-442-6436).
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Manufactured by Immunex Corporation
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All rights reserved. USA-916-84136
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