Celltrion CONNECT Patient Assistance Program:
Definition, Rules and Eligibility, and Terms and Conditions

1. Description

The Celltrion CONNECT® Patient Assistance Program (PAP) is designed to provide free product to qualified individuals who are uninsured or are functionally uninsured, who have no applicable drug coverage, or who express financial hardship affording their medication. Celltrion CONNECT® will help activate PAP for eligible participants.

2. Eligibility Criteria

Patient Assistance Program eligibility: To receive PAP benefits, the patient must enroll in the program and meet the following eligibility requirements:

  1. Patient has no insurance or who is functionally uninsured:
    1. Patients who do not have insurance (uninsured) or are insured, but product is not covered by their plan (Patient is responsible for 100% of product cost) (functionally uninsured).
      1. Functionally uninsured includes all payor types:
        1. For commercial patients who have exhausted their co-pay benefits through Celltrion CARESTM Co-pay Assistance Program.
      2. In order to be considered functionally uninsured:
        1. The patient has medical and/or pharmacy benefits but the payor/pharmacy benefit manager (PBM) will not approve or pay for either the entirety or any portion of the medication.
          1. The payor/PBM must deny one level of appeal of an initial coverage denial.
        2. Does not have coverage for any other product (originator or biosimilars in same class).
    2. Medicare patients that are underinsured (i.e., patient has coverage with a cost share and has expressed a financial hardship affording their cost share).
  2. Patient must be 18 years or older.
  3. Patient must have a valid prescription from a licensed healthcare provider (HCP) for an on-label indication.
  4. Patient must have an adjusted annual household income of ≤500% of the federal poverty level (FPL).
  5. Income verification:
    1. If the electronic income check fails or the patient has not provided consent for income credit check, then Celltrion CONNECT® will request income documentation from the patient.
    2. Income documentation accepted includes tax returns (1040, 1099), W-2s, 30 days of pay stubs, unemployment letters and unemployment government assistance, if applicable. Social Security statements or Social Security verification letter.
  6. Patient must show proof of residency by providing valid United States or the Commonwealth of Puerto Rico address and product must be administered in the United States or the Commonwealth of Puerto Rico.
  7. Diagnosis and dosing are consistent with FDA-approved indication for VEGZELMA® (bevacizumab-adcd).
  8. Patient must not have any other financial support options. Patient has exhausted alternative funding or has confirmed no funds are available.
  9. If patient is approved through PAP, they must remain in PAP and receive free drug through the Celltrion CONNECT® PAP program until the end of the calendar year that they were approved for. For example, if the patient was approved for PAP in July of 2023, they will remain enrolled in the PAP program until December 31st, 2023.