The Celltrion CARES^™ Co-pay Assistance Program allows eligible patients to receive up to $25,000 of co-pay assistance per calendar year. Eligible patients may pay as little as $0 for VEGZELMA® (bevacizumab-adcd).

To be eligible for Celltrion CARES^™ Co-pay Assistance Program, patients must:

1. Have commercial insurance
2. Not have Medicare, Medicaid, or other government insurance
3. Meet the criteria listed in the Terms and Conditions for the Celltrion CARES^™ Co-pay Assistance Program

• To qualify for Co-pay Assistance Program benefits, the patient must enroll in the program and meet the following eligibility requirements:
  • Patient must have private/commercial health insurance that provides coverage for the cost of VEGZELMA.
  • Patients do not qualify if they are covered, in whole or in part, under Medicaid (including Medicaid patients enrolled in a qualified health plan purchased through a health insurance exchange [marketplace] established by a state government or the federal government), Medicare, a Medicare Part D or Medicare Advantage plan (regardless of whether a specific prescription is covered), TRICARE, CHAMPUS, Puerto Rico Government Health Insurance Plan (“Healthcare Reform”), or any other state or federal medical or pharmaceutical benefit program or pharmaceutical assistance program (collectively, “Government Programs”).
  • Patient must be a resident of the United States or the Commonwealth of Puerto Rico. Product must originate and be administered to patient in the United States or the Commonwealth of Puerto Rico.
  • Patient must be under the care of a physician for one of the following FDA-approved indications:
    
    1. Metastatic colorectal cancer, in combination with intravenous fluorouracil-based chemotherapy for first- or second-line treatment.
    2. Metastatic colorectal cancer, in combination with fluoropyrimidine irinotecan- or fluoropyrimidine-oxaliplatin-based chemotherapy for second-line treatment in patients who have progressed on a first-line bevacizumab product-containing regimen.
    3. Unresectable, locally advanced, recurrent or metastatic non-squamous non-small cell lung cancer, in combination with carboplatin and paclitaxel for first-line treatment.
    4. Recurrent glioblastoma in adults.
    5. Metastatic renal cell carcinoma in combination with interferon alfa.
    6. Persistent, recurrent, or metastatic cervical cancer, in combination with paclitaxel and cisplatin, or paclitaxel and topotecan.
    7. Epithelial ovarian, fallopian tube, or primary peritoneal cancer:
       
       1. In combination with carboplatin and paclitaxel, followed by VEGZELMA as a single agent, for stage III or IV disease following initial surgical resection.
       2. In combination with paclitaxel, pegylated liposomal doxorubicin, or topotecan for platinum-resistant recurrent disease who received no more than 2 prior chemotherapy regimens.
       3. In combination with carboplatin and paclitaxel or carboplatin and gemcitabine, followed by VEGZELMA as a single agent, for platinum-sensitive recurrent disease.
  • Patient must have an out-of-pocket cost for VEGZELMA and be administered VEGZELMA prior to the expiration date of the Co-pay Assistance Program. The benefit available under the Co-pay Assistance Program is valid for the patient’s out-of-pocket cost for VEGZELMA only. It is not valid for any other out-of-pocket costs (for example, office visit charges or medication administration charges) even if such costs are associated with the administration of VEGZELMA. A claim for VEGZELMA must be submitted by the provider to the patient’s private health insurance separately from any other services and products.
• Eligible patients may pay as little as $0 for VEGZELMA. The benefit available under the Co-pay Assistance Program is limited to the amount the patient’s private health insurance company indicates on the Explanation of Benefits (EOB) that the patient is obligated to pay for VEGZELMA up to an annual maximum. The maximum Co-pay Assistance Program benefit per patient, per calendar year (January 1 through December 31), is $25,000. Enrolled patients are responsible for all co-pays and any other balances not covered by the Co-pay Assistance Program.
• An Explanation of Benefits (EOB) from patient’s private health insurance must be submitted within 180 days of the date of administration for the patient to receive any applicable co-pay assistance benefit; provided, however, that no EOB may be submitted more than 365 days after the expiration date of Co-pay Assistance Program. The EOB must reflect the patient’s out-of-pocket cost for VEGZELMA and submission of the claim by the patient’s provider for the cost of VEGZELMA.
• Patient and provider agree not to seek reimbursement for all or any part of the benefit received by the patient through the Co-pay Assistance Program. Patient and provider are responsible for reporting receipt of Co-pay Assistance Program benefits to any insurer, health plan, or other third party who pays for or reimburses any part of the medication cost paid for by the Co-pay Assistance Program, as may be required.
• The Co-pay Assistance Program
  • May apply to patient out-of-pocket costs incurred for VEGZELMA within 180 days prior to the date patient is enrolled in the Co-pay Assistance Program, subject to annual Program maximum and the applicable Terms and Conditions based on VEGZELMA administration date. Patient or provider may contact Celltrion CARES™ for more information.
  • Is not insurance. If your insurance status changes, you must notify Celltrion CARES™ immediately.
  • Is void where prohibited by law, taxed, or restricted.
  • Is not transferable. No substitutions are permitted.
  • Cannot be combined with any other Co-pay Assistance Program, free trial, discount, prescription savings card, or other offer.
  • Is not contingent on any past or commercial sale of any VEGZELMA.
• Celltrion CARES™ reserves the right to rescind, revoke, or amend the Co-pay Assistance Program at any time without notice.
• These Terms and Conditions are valid for VEGZELMA administered between April 3, 2023 and December 31, 2023. These terms and conditions may be changed without prior notice.