Eligibility Criteria: Subject to program limitations and terms and conditions, the Otezla Co-Pay Card is open to patients who have an Otezla prescription and who have commercial or private insurance, including plans available through state and federal healthcare exchanges. This program helps eligible patients cover out-of-pocket costs related to Otezla, up to program limits. There is no income requirement to participate in this program.
This offer is not valid for patients whose Otezla prescription is paid for in whole or in part by Medicare, Medicaid, or any other federal or state programs. It is not valid for cash-paying patients or where prohibited by law. A patient is considered cash-paying where the patient has no insurance coverage for Otezla or where the patient has commercial or private insurance but Amgen in its sole discretion determines the patient is effectively uninsured because such coverage does not provide a material level of financial assistance for the cost of an Otezla prescription.
II. PROGRAM BENEFITS
The Otezla Co-Pay Card helps provide out-of-pocket support to eligible patients for their Otezla prescription up to program limits. With the Otezla Co-Pay Card, a commercially insured patient who meets eligibility criteria can receive one of two offers when filling their Otezla prescription: the Bridge Offer and/or the Co-Pay Card Offer. Patients can participate in one offer at a time. See PROGRAM DETAILS for full description.
The Otezla Co-Pay Card offer does not cover out-of-pocket costs for any patient whose selected coverage option under their commercial insurance plan does not apply Otezla Co-Pay Card payments to satisfy the patient's co-payment, deductible, or co-insurance for Otezla. Patients with these plan limitations are not eligible for the Otezla Co-Pay Card but may be eligible for other needs-based assistance provided by Amgen. These programs are often referred to as accumulator adjustment programs. If you believe your commercial insurance plan may have such limitations, please contact Otezla SupportPlus at 1-844-4OTEZLA (1-844-468-3952).
The Otezla Co-Pay Card also may provide a reduced benefit amount, unilaterally determined by Amgen in its sole discretion, to satisfy the out-of-pocket cost-sharing requirement for any patient whose plan or plan agent (including, but not limited to, a Pharmacy Benefit Manager [PBM]) requires enrollment in the Otezla Co-Pay Card as a condition of the plan or PBM waiving some or all of an otherwise applicable patient out-of-pocket cost-sharing amount. These programs are often referred to as co-pay maximizer programs. If you believe your commercial insurance plan may have such limitations, please contact Otezla SupportPlus at 1-844-4OTEZLA (1-844-468-3952). Health plans, specialty pharmacies, and Pharmacy Benefit Managers (individually and collectively "Plan Administrators") are prohibited from enrolling patients in the Otezla Co-Pay Card. Plan Administrators are prohibited from assisting patients with enrollment in the Otezla Co-Pay Card. The patient, or his/her legal representative, must personally enroll in the Otezla Co-Pay in order to be eligible for program benefits.
If at any time a patient begins receiving prescription drug coverage under any state or government program (including but not limited to Medicare, Medicaid, TRICARE, Department of Defense, or Veteran Affairs programs), the patient will no longer be able to use this card and they must contact Otezla SupportPlus at 1-844-4OTEZLA (1-844-468-3952) (Monday through Friday, from 8AM-8PM ET) to stop their participation in this program.
Patients may not seek reimbursement for the value received from the Otezla Co-Pay Card from any third-party payers, including a flexible spending account or healthcare savings account. Participating in this program means that you are ensuring you comply with any required disclosure regarding your participation in the Otezla Co-Pay Card of your insurance carrier or Pharmacy Benefit Manager. Restrictions may apply. Offer is subject to change or discontinuation without notice. This is not health insurance.
III. PROGRAM DETAILS
With the Otezla Co-Pay Card, a commercially insured patient who meets eligibility criteria can receive one of the following two offers when filling their Otezla prescription:
Bridge to Commercial Coverage Offer
You must not take Otezla if you are allergic to apremilast or to any of the ingredients in Otezla.
Otezla can cause allergic reactions, sometimes severe. Stop using Otezla and call your healthcare provider or seek emergency help right away if you develop any of the following symptoms of a serious allergic reaction: trouble breathing or swallowing, raised bumps (hives), rash or itching, swelling of the face, lips, tongue, throat or arms.
Otezla can cause severe diarrhea, nausea, and vomiting, especially within the first few weeks of treatment. Use in elderly patients and the use of certain medications with Otezla appears to increase the risk of complications from having severe diarrhea, nausea, or vomiting. Tell your doctor if any of these conditions occur.
Otezla is associated with an increase in depression. In clinical studies, some patients reported depression, or suicidal behavior while taking Otezla. Some patients stopped taking Otezla due to depression. Before starting Otezla, tell your doctor if you have had feelings of depression, or suicidal thoughts or behavior. Be sure to tell your doctor if any of these symptoms or other mood changes develop or worsen during treatment with Otezla.
Some patients taking Otezla lost body weight. Your doctor should monitor your weight regularly. If unexplained or significant weight loss occurs, your doctor will decide if you should continue taking Otezla.
Some medicines may make Otezla less effective, and should not be taken with Otezla. Tell your doctor about all the medicines you take, including prescription and nonprescription medicines.
The most common side effects of Otezla include diarrhea, nausea, upper respiratory tract infection, tension headache, and headache. These are not all the possible side effects with Otezla. Ask your doctor about other potential side effects. Tell your doctor about any side effect that bothers you or does not go away.
Tell your doctor if you are pregnant, planning to become pregnant or planning to breastfeed.
Please click here for the Full Prescribing Information for Otezla.
Otezla® (apremilast) is a prescription medicine used to treat adult patients with: