Terms and Conditions for Drug Assistance

This OCREVUS Co-pay Program is valid ONLY for patients with commercial (private or non-governmental) insurance who have a valid prescription for a Food and Drug Administration (FDA)-approved indication of a Genentech medication. Patients using Medicare, Medicaid, Medigap, Veteran's Affairs (VA), Department of Defense (DoD), TRICARE or any other federal or state government program (collectively, "Government Programs") to pay for their medications are not eligible. The program is not valid for medications that are eligible to be reimbursed in their entirety by private insurance plans or other programs.

Under the program, the patient will pay a co-pay. After reaching the maximum program benefit, the patient will be responsible for all remaining out-of-pocket expenses. This program is not health insurance or a benefit plan. The program does not obligate the use of any specific product or provider. Patients receiving assistance from charitable assistance programs (such as Genentech Patient Foundation) are not eligible. The co-pay benefit cannot be combined with any other rebate, free trial or similar offer for the medication. No party may seek reimbursement for all or any part of the benefit received through this program.

The program may be accepted by participating pharmacies, physician offices or hospitals. Once a patient is enrolled, this program will not honor claims with date of service or medication dispensing that precede program enrollment by more than 180 days. Use of this program must be consistent with all relevant health insurance requirements. Participating patients, pharmacies, physician offices and hospitals are responsible for reporting the receipt of all program benefits as required by any insurer or by law. Program benefits may not be sold, purchased, traded or offered for sale.

The patient or their guardian must be 18 years or older to receive program assistance. This program is only valid in the United States and U.S. Territories. This program is void where prohibited by law and shall follow state restrictions in relation to AB-rated generic equivalents (e.g., MA, CA) where applicable. Program eligibility is contingent upon the patient's ability to meet and maintain all requirements set forth by the program. Genentech reserves the right to rescind, revoke or amend the program without notice at any time.

Terms and Conditions for Infusion Assistance

The OCREVUS Administration Co-pay Program is valid ONLY for patients with commercial (private or non-governmental) insurance who have a valid prescription for a Food and Drug Administration (FDA)-approved indication of a Genentech medication. Patients using Medicare, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DoD), TRICARE or any other federal or state government funded program (collectively, "Government Programs") to pay for their medications and/or administration services are not eligible. If the patient chooses to enroll in the OCREVUS Drug Co-pay Program, the patient must separately enroll and meet all eligibility criteria of that program.

Under the program, the patient will pay a co-pay. After reaching the maximum per treatment or annual limit, the patient will be responsible for all remaining out-of-pocket expenses. The amount of the program benefit cannot exceed the patient's out-of-pocket expenses for the cost of administrative fees associated with OCREVUS. This program is not health insurance or a benefit plan. Distribution or use of the program does not obligate use or continuing use of any specific product or provider. The patient, guardian, prescriber, hospital and any other person using or administering the program agree not to seek reimbursement for any part of the benefit received by the patient through the offer of this program.

The program may be accepted by participating pharmacies, physician offices or hospitals. Once a patient is enrolled, this program will not honor claims with date of service or medication dispensing that precede program enrollment by more than 180 days. Use of this program must be consistent with all relevant health insurance requirements. Participating patients, pharmacies, physician offices and hospitals are responsible for reporting the receipt of all program benefits as required by any insurer or by law. Program benefits may not be sold, purchased, traded or offered for sale.

The patient or their guardian must be 18 years or older to receive program assistance. The program is only valid in the United States and U.S. Territories. The program is not valid for Massachusetts or Rhode Island residents. This program is not valid where prohibited by law.

This program cannot be combined with any other rebate/coupon, free trial or similar offer for the specified prescription, except the OCREVUS Drug Co-pay Program. The program is valid for patients receiving free product from Genentech. The program is not valid for patients receiving product that may be subsidized by a non-Genentech charitable organization or healthcare plan.

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.

Product & Administration Combined Terms and Conditions

The OCREVUS Product and Administration Co-pay Program is valid ONLY for patients with commercial (private or non-governmental) insurance who have a valid prescription for a Food and Drug Administration (FDA)-approved indication of a Genentech medication. Patients using Medicare, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DoD), TRICARE or any other federal or state government funded program (collectively, "Government Programs") to pay for their medications and/or administration services are not eligible.

Under the programs, the patient will pay a co-pay. After reaching the maximum per treatment or annual limit, the patient will be responsible for all remaining out-ofpocket expenses. The amount of the program's benefits cannot exceed the patient's out-of-pocket expenses for the cost of the drug or administration fees associated with OCREVUS. These programs are not health insurance or a benefit plan. Distribution or use of the programs does not obligate use or continuing use of any specific product or provider. The patient, guardian, prescriber, hospital and any other person using or administering the programs agree not to seek or receive payment or reimbursement from any other source for any of the out of pocket costs that are covered by these programs.

The programs may be accepted by participating pharmacies, physician offices or hospitals. Once a patient is enrolled, the programs will not honor claims with date of service or medication dispensing that precede program enrollment by more than 180 days. Use of these programs must be consistent with all relevant health insurance requirements. Participating patients, pharmacies, physician offices and hospitals are responsible for reporting the receipt of all program benefits as required by any insurer or by law. Program benefits may not be sold, purchased, traded or offered for sale.

The patient or their guardian must be 18 years or older to receive program assistance. The programs are only valid in the United States and U.S. Territories. The programs are void where prohibited by law. The product co-pay program shall follow state restrictions in relation to AB-rated generic equivalents (e.g., MA, CA) where applicable. The administration co-pay program is not valid for Massachusetts or Rhode Island residents.

This program cannot be combined with any other rebate/coupon, free trial or similar offer for the specified prescription. The product program is not available or valid for patients receiving free product from the Genentech Patient Foundation. The administration program is valid for patients receiving free product from the Genentech Patient Foundation. The product and administration programs are not valid for patients receiving support for out-of-pocket costs for product or administration services covered by these programs that are or may be subsidized or reimbursed by an independent charitable organization or a healthcare plan. 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.

Indication and Important Safety Information

What is OCREVUS?

OCREVUS is a prescription medicine used to treat:

  • Relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults
  • Primary progressive MS, in adults.

It is not known if OCREVUS is safe and effective in children.

Who should not receive OCREVUS?

Do not receive OCREVUS if you have an active hepatitis B virus (HBV) infection.
Do not receive OCREVUS if you have had a life-threatening allergic reaction to OCREVUS. Tell your healthcare provider if you have had an allergic reaction to OCREVUS or any of its ingredients in the past.

What is the most important information I should know about OCREVUS?

OCREVUS can cause serious side effects, including:

  • Infusion reactions: Infusion reactions are a common side effect of OCREVUS, which can be serious and may require you to be hospitalized. You will be monitored during your infusion and for at least 1 hour after each infusion of OCREVUS for signs and symptoms of an infusion reaction.
  • Infection: OCREVUS increases your risk of getting upper respiratory tract infections, lower respiratory tract infections, skin infections, and herpes infections. Infections are a common side effect, which can be serious. Tell your healthcare provider right away if you have an infection. Your healthcare provider should delay your treatment with OCREVUS until your infection is gone
  • Decreased immunoglobulins: OCREVUS may cause a decrease in some types of immunoglobulins. Your healthcare provider will do blood tests to check your blood immunoglobulin levels.

What are the possible side effects of OCREVUS?

OCREVUS may cause serious side effects, including:

  • Risk of cancers (malignancies) including breast cancer. Follow your healthcare provider’s instructions about standard screening guidelines for breast cancer.

These are not all the possible side effects of OCREVUS.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

For more information, go to www.OCREVUS.com or call 1-844-627-3887.

For additional safety information, please see the full Prescribing Information and Medication Guide.