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`GENENTECH BIOONCOLOGY CO-PAY CARD - PERJETA
`
`Genentech Inc.
`Card covers at least 80% of the out-of-pocket costs for each Genentech cancer treatment. You pay 20%
`(but no more than $100). Card limit up to $24.000 per year. If your yearly household income is
`>$100,000 your yearly card limit is $9,000.
`
`Contact Information:
`Phone: (888) 249-4918
`
`How to Apply:
`Select one of the links below to download the application or go to the program site for more
`information on how to apply. Once you fill out your application, send it to the address on the
`application. Remember not to send program applications to the PPA.
`
`Click here to visit the program's website
`
`Eligibility:
`You cannot be covered by a government-funded health care program such as Medicare, Medicaid,
`Medigap, VA, DoD or Tricare.
`
`You must be age 18 years or older, currently live or get treatment in the United States or Puerto Rico.
`
`If you are receiving funding from the Genentech® Access to Care Foundation, you are not eligible for the
`Genentech BioOncology Co pay Card.
`
`Vermont state laws do not allow programs like this one.
`
`Product(s) covered by program:
`- Perjeta®
`
`© 2014 Partnership for Prescription Assistance
`Program Database last updated on December 16, 2014
`Privacy Policy | Terms of Use
`
`https://www.pparx.org/prescription_assistance_programs/genentech_biooncology_co_pay_card_perjeta[12/30/2014 2:56:15 PM]
`
`IMMUNOGEN 2333, pg. 1
`Phigenix v. Immunogen
`IPR2014-00676
`
`
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