Terms and Conditions

The Pulmozyme Voucher Program

By using the Voucher, the patient (or legal guardian) and pharmacist, respectively, acknowledges and certifies that the eligibility criteria are met and each agrees to comply with the Terms and Conditions described below:

  • The Pulmozyme Voucher ("voucher") is a Free Trial offer that may only be used with a valid prescription for an FDA-approved indication of Pulmozyme.
  • Patients are limited to receive one voucher at the start of their treatment with Pulmozyme. The Voucher provides up to a 30-day supply of Pulmozyme at $0 to the patient. This voucher expires 12 months from the date it is activated.
  • No purchase is required. The voucher is not conditioned on any past, present or future purchase.
  • This voucher may only be fulfilled through participating pharmacies.
  • The patient or their guardian redeeming this voucher must be 18 years or older.
  • No claim (including by patients, pharmacists, or prescribers) in connection with this voucher program may be submitted to any federal healthcare program including Medicare, Medicaid, Veteran's Affairs (VA), Department of Defense (DOD), TRICARE or any other federal or state programs, under any private insurance, HMO, or other third party payment arrangement for reimbursement, or (b) to count toward out-of-pocket cost (OOP) under any healthcare plan, including true out-of-pocket costs ("TrOOP"), under Medicare Part D, or (c) to count toward a HealthCare or Flex spending (HSA or FSA) pre-tax account.
  • This offer is not health insurance or a benefit plan.
  • Healthcare providers/pharmacists may not advertise or otherwise use this program as a means of promoting their services or Genentech's product to patients
  • Offer only valid in the United States and U.S. Territories. Not valid in California or Massachusetts if an AB-rated generic equivalent becomes available for the product. Void where prohibited by law.
  • The voucher may not be sold, purchased, traded, or offered for sale, purchase, or trade. This offer is not transferable and may not be combined with any other offer.
  • Genentech reserves the right to rescind, revoke, or amend the voucher program without notice at any time.

The Pulmozyme Co-pay Program

This Pulmozyme 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.

Important Safety Information & Indication

 

Indication and Usage

Pulmozyme (dornase alfa) is indicated, along with standard therapies, for the management of pediatric and adult patients with cystic fibrosis (CF) to improve pulmonary function.

In CF patients with an FVC ≥ 40% of predicted, daily administration of Pulmozyme has also been shown to reduce the risk of respiratory tract infections requiring injectable antibiotics.

Important Safety Information

Pulmozyme should not be used in patients who are allergic to any of its ingredients.

Patients may experience the following when using Pulmozyme: change in or loss of their voice, discomfort in the throat, rash, chest pain, red watery eyes, runny nose, lowering of lung function, fever, indigestion, and shortness of breath. There have been no reports of severe allergic reactions caused by the administration of Pulmozyme. Mild to moderate hives and mild skin rash have been observed and have been short-lived.

Pediatric Use

The safety and effectiveness of Pulmozyme along with standard therapies for cystic fibrosis have been established in pediatric patients. The use of Pulmozyme in pediatric patients at 5 to 17 years of age is supported by evidence from a randomized, controlled trial. The use of Pulmozyme in patients less than 5 years of age is supported by the efficacy data from the same randomized, controlled trial and additional safety data in pediatric patients aged 3 months to less than 5 years who received Pulmozyme.

You are encouraged to report side effects to Genentech and the FDA. You may report side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at 1-888-835-2555.

For further information, please see the full Pulmozyme Prescribing Information. If you have questions, please discuss them with your CF Care Team.