Celgene Commercial Co-pay Program Terms and Conditions
Eligibility
Patients must meet the following criteria to enroll:
- Covered by commercial or private insurance
- Reside in the United States or US territory
- Not participating in a federal or state-funded healthcare program, including, but not limited to, Medicare (Parts B, C, and D) or Medicaid, Medigap, CHAMPUS, VA, DOD, or Tricare
- Gross annual household income must not exceed $100,000
- Gross household income is the total income before income tax deductions from all people living in your household. Gross income refers not only to the salaries and benefits received, but also to receipts from any personal business, investments, dividends, and other income
Program Benefits
- For Celgene oral hematology products, Celgene provides assistance to reduce the co-pay of eligible patients to $25 per prescription with a maximum benefit of $10,000 per enrollment period
- For Celgene IV products, the Program will cover the co-pay for each prescription of a Celgene product up to a maximum of $10,000 per enrollment period
- In order to receive the Program benefits for a Celgene IV product, patients or their providers must submit an Explanation of Benefits (EOB) form
- Patients are responsible for any costs that exceed the Program’s $10,000 maximum
- The Program will not cover, and shall not be applied toward, the cost of any dosing procedure, any other healthcare provider service or supply charges or other treatment costs, or any costs associated with a hospital stay
Program Timing
- If eligible, patients will be enrolled from the date of enrollment through the end of the then current calendar year
Additional Terms and Conditions of the Celgene Commercial Co-pay Programs
- Patients, pharmacists, and healthcare providers must not seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this Program. Patients must not seek reimbursement from any health savings, flexible spending, or other healthcare reimbursement accounts for the amount of assistance received from the Program
- Acceptance of this offer confirms that this offer is consistent with your insurance and that you will report the value of the co-pay assistance you receive as may be required by your insurance provider
- Only valid in the United States and US territories; this offer is void where prohibited by law, taxed or restricted. Absent a change in Massachusetts law, effective July 1, 2019, Massachusetts residents will no longer be eligible to participate in this Program
- The Program benefits are nontransferable
- Acceptance in this Program is not conditioned on any past, present, or future purchase, including additional doses
- The Program cannot be combined with any other coupon, rebate, voucher, free trial, or similar offer
- The Program is not insurance
- Celgene reserves the right to rescind, revoke, or amend this Program at any time without notice
© 2017 Celgene Corporation 06/17 US-CELG170216