By using the Valcyte® Co-pay Card program, the patient acknowledges and confirms that at the time of usage, he/she is currently eligible and meets the criteria set forth in the Terms and Conditions described.
This Co-pay Card is valid ONLY for patients with commercial (private or non-governmental) insurance. It is not valid for patients who are government beneficiaries or whose medications are covered, in whole or in part, under Medicaid, Medicare Parts A, B, C, and/or D, TRICARE, CHAMPUS, Puerto Rico Government Health Insurance Plan, or any other state or federal healthcare program. Patients who become government beneficiaries during their enrollment period will no longer be eligible for the program as of the date they become government beneficiaries.
This Co-pay Card program is not health insurance or a benefit plan. Distribution or use of the Co-pay Card does not obligate use or continuing use of any specific product or provider. Patient or guardian is responsible for reporting the receipt of all Co-pay Card program benefits or reimbursement received to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the Co-pay Card program, as may be required.
The Co-pay Card is not valid for medications the patient receives for free or that are eligible to be reimbursed by private insurance plans or other healthcare or pharmaceutical assistance programs (such as GATCF or any other charitable organization) that reimburse the patient in part or for the entire cost of his/her medication. Patient, guardian, pharmacist, prescriber, and any other person using the Co-pay Card agree not to seek reimbursement for all or any part of the benefit received by the recipient through the offer.
The Co-pay Card will be accepted by participating pharmacies, physician offices, or hospitals. To qualify for the benefits of this Co-pay Card program, the patient may be required to pay out-of-pocket expenses for each treatment. Once the patient is enrolled, this Co-pay Card program will not honor claims with dates of service or medication dispensing that precede program enrollment by more than 120 days. This Co-pay Card is only available with a valid prescription and cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription. Use of this Co-pay Card must be consistent with all relevant health insurance requirements and payer agreements. Participating patients, pharmacies, physician offices, and hospitals are obligated to inform third-party payers about the use of the Co-pay Card as provided for under the applicable insurance or as otherwise required by contract or law. The Co-pay Card may not be sold, purchased, traded, or offered for sale, purchase, or trade. The Co-pay Card is limited to 1 per person during this offering period and is not transferable. This program expires within 12 months from enrollment. This program is not valid where prohibited by law. For Massachusetts residents, the Co-pay Card is not valid for any prescription drug that has an AB-rated generic equivalent as determined by the United States Food and Drug Administration. For Massachusetts residents, this program shall expire on or before July 1, 2017.
The patient or their guardian must be 18 years or older to receive Co-pay Card program assistance. This Co-pay Card program is: (1) void if the card is reproduced; (2) void where prohibited by law; (3) only valid in the United States and Puerto Rico; and (4) only valid for Genentech products. Healthcare providers may not advertise or otherwise use the program as a means of promoting their services or Genentech’s products to patients. Genentech, Inc., reserves the right to rescind, revoke, or amend the program without notice at any time.