Terms and Conditions
The Pulmozyme Voucher Program
The Pulmozyme Voucher ("Voucher") is a Free Trial offer that may only be used with a valid prescription of Pulmozyme. The Voucher does not obligate use or continuing use of Pulmozyme or any provider. This Voucher is only valid for prescriptions filled in United States and U.S. Territories and is void where prohibited by law. The Voucher may only be fulfilled through participating retail and specialty pharmacies.
By using the Voucher, the patient acknowledges and confirms that at the time of usage, they are currently eligible and meet the criteria set forth in the terms and conditions described. Patients must have a valid prescription for an FDA approved indication for Pulmozyme. Patients under the age of 18 must be enrolled by their Legal Guardian.
Patients are NOT eligible for the Pulmozyme Voucher Program, (a) if this claim will be submitted under any federal healthcare program including Medicare, Medicaid, or any similar federal or state programs including any state assistance programs, under any private insurance, HMO, or other third party payment arrangement for reimbursement, or (b) this will be submitted to count toward your out-of-pocket cost under your prescription drug plan, or (c) submitted to a HealthCare or Flex spending (HSA or FSA) pre-tax account.
The Voucher provides up to 30-day supply of therapy at $0 to the patient. Patients are limited to receive one voucher at the start of their treatment with Pulmozyme. Healthcare providers may not advertise or otherwise use the program as a means of promoting their services or Pulmozyme to patients. This Voucher cannot be combined with any other rebate, coupon, free trial, or similar offer for the specified prescription. This voucher expires 12 months from the activation date. The Voucher may not be sold, purchased, traded, or offered for sale, purchase, or trade. This Voucher is not health insurance or a benefit plan. Genentech reserves the right to rescind, revoke, or amend the Voucher Program without notice at any time.
The Pulmozyme Co-pay Program
By using the Pulmozyme Co-pay Program, the patient acknowledges and confirms that, at the time of usage, (s)he is currently eligible and meets the criteria set forth in the terms and conditions described.
This Copay Card is valid ONLY for patients with commercial (private or non-governmental) insurance who are taking the medication for a Food and Drug Administration (FDA)-approved indication. Patients using Medicare, Medicaid, Medigap, Veteran's Affairs (VA), Department of Defense (DoD), TriCare or any other government-funded program to pay for their medications are not eligible. Patients who start utilizing their government coverage during their enrollment period will no longer be eligible for the program.
This Copay Card Program is not health insurance or a benefit plan. Distribution or use of the Copay Card does not obligate use or continuing use of any specific product or provider. Patient or guardian is responsible for reporting the receipt of all Copay Card Program benefits or reimbursement received to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the Copay Card Program, as may be required.
The Copay Card is not valid for medications the patient receives for free or that are eligible to be reimbursed by private insurance plans or other healthcare or pharmaceutical assistance programs (such as Genentech® Patient Foundation or any other charitable organization) that reimburse the patient in part or for the entire cost of his/her Genentech medication. Patient, guardian, pharmacist, prescriber, and any other person using the Copay Card agree not to seek reimbursement for all or any part of the benefit received by the recipient through this Copay Card Program.
The Copay Card may be accepted by participating pharmacies, physician offices, or hospitals. To qualify for the benefits of this Copay Card Program, the patient may be required to pay out-of-pocket expenses for each treatment. Once enrolled, this Copay Card Program will not honor claims with date of service or medication dispensing that precede program enrollment by more than 120 days. This Copay Card is only available with a valid prescription and cannot be combined with any other rebate, free trial, or similar offer for the specified prescription. Use of this Copay Card must be consistent with all relevant health insurance requirements and payer agreements. Participating patients, pharmacies, physician offices, and hospitals are obligated to inform third-party payers about the use of the Copay Card as provided for under the applicable insurance or as otherwise required by contract or law. The Copay Card may not be sold, purchased, traded, or offered for sale, purchase, or trade. The Copay Card is limited to 1 per person during this offer period and is not transferable. Program eligibility period is contingent upon patient's ability to meet and maintain all requirements as set forth by the program. Genentech will periodically verify eligibility and will terminate patients without obligation to pay claims if change to status is detected. This program is not valid where prohibited by law, and shall follow state restrictions in relation to AB-rated generic equivalents where applicable (e.g. MA, CA).
The patient or their guardian must be 18 years or older to receive Copay Card Program assistance. This Copay Card Program is (1) void if the card is reproduced; (2) void where prohibited by law; (3) only valid in the United States and U.S. Territories; and (4) only valid for Genentech products. Healthcare providers may not advertise or otherwise use the program as a means of promoting their services or Genentech's products to patients. Genentech reserves the right to rescind, revoke, or amend the program without notice at any time.