Patient Assistance - Cetrorelix Acetate

Apotex is pleased to offer financial assistance with cost-sharing for Cetrorelix Acetate manufactured and labeled by Apotex to eligible commercially insured patients through the Cetrorelix Acetate Instant Savings^† Program:

Do you have commercial health insurance?

You may be eligible for the Cetrorelix Acetate Instant Savings^† Program

If eligible, commercially insured patients may pay as little as $0^† out-of-pocket cost with the Cetrorelix Acetate Instant Savings Card toward each 30-day supply, and the program will pay up to $50 per 30-day supply not covered by primary insurance, up to $600 per calendar year.
Patients must deduct the savings received under this program from any reimbursement request submitted to their insurance plan, either directly by them or on their behalf.

Follow these simple steps for your Cetrorelix Acetate Instant Savings^† Program Card:

Review the Terms and Conditions below.
Click Enroll to agree to the Terms and Conditions.
Print your Cetrorelix Acetate Instant Savings^† Program Card and bring it to a participating local pharmacy.

CLICK HERE to review the Cetrorelix Acetate Instant Savings^† Program Terms and Conditions:

I understand this offer is not valid for patients who are uninsured or have no prescription drug coverage for Cetrorelix Acetate, or for patients whose prescriptions are paid for in whole or in part by either Medicaid, Medicare, TRICARE, the Federal Employee Health Benefits program, or any other Federal or State funded program.
I verify I have commercial health insurance and agree to the Terms and Conditions.

ENROLL

^†Click Enroll to agree to the Terms and Conditions and verify that you meet the eligibility requirements and get your printable Cetrorelix Acetate Instant Savings^† Program Card.

If you have any questions regarding your eligibility or benefits, or if you wish to discontinue your participation, please call (833) 404-5435.

Patient

Show the Cetrorelix Acetate Instant Savings^† card with your Cetrorelix Acetate prescription at any participating pharmacy.
If eligible, commercially insured patients may pay as little as $0^† out-of-pocket cost with the Cetrorelix Acetate Instant Savings Card toward each 30-day supply, and the program will pay up to $50 per 30-day supply not covered by primary insurance, up to $600 per calendar year.
By using this card, the patient acknowledges meeting the eligibility requirements and complying with our Terms and Conditions.
For questions about eligibility or about using the card, please call toll free at (833) 404-5435.

Pharmacist

For Commercially Insured Patients presenting the Cetrorelix Acetate Instant Savings Program card for whom you have dispensed Cetrorelix Acetate, NDC: 60505-6270-01: Process a coordination of benefits claim (COB/split bill) by using the patient's prescription insurance for the PRIMARY claim.
Submit a SECONDARY claim to CapitalRx under Bin: 610852 and PCN: 2001.
For questions about processing the card, please call toll free at (833) 404-5435.

Limitations Apply

Offer not valid for patients who are uninsured or have no prescription drug coverage for Cetrorelix Acetate or those with prescription drug coverage under Medicaid, Medicare, TRICARE, the Federal Employee Health Benefit Program or any other federal or state health care program or if the patients receive full reimbursement for prescriptions from private insurance plans or other health or pharmacy benefit programs (i.e. there is no cost-sharing obligation).

INDICATION AND IMPORTANT SAFETY INFORMATION

What is CETRORELIX ACETATE FOR INJECTION?
CETRORELIX ACETATE FOR INJECTION is a medication that prevents premature LH surges in women undergoing controlled ovarian stimulation during fertility treatment.

Who should not take CETRORELIX ACETATE FOR INJECTION?
CETRORELIX ACETATE FOR INJECTION should not be taken by people with the following conditions:

Hypersensitivity to cetrorelix acetate, extrinsic peptide hormones or mannitol.
Known hypersensitivity to GnRH or any other GnRH analogs.
Known or suspected pregnancy, and lactation.
Severe renal impairment.

What is the most important information I should know about CETRORELIX ACETATE FOR INJECTION?

CETRORELIX ACETATE FOR INJECTION should be prescribed by physicians who are experienced in fertility treatment. Before starting treatment with CETRORELIX ACETATE FOR INJECTION, pregnancy must be excluded.

INDICATION AND IMPORTANT SAFETY INFORMATION

Who should not take CETRORELIX ACETATE FOR INJECTION?
CETRORELIX ACETATE FOR INJECTION should not be taken by people with the following conditions:

Hypersensitivity to cetrorelix acetate, extrinsic peptide hormones or mannitol.
Known hypersensitivity to GnRH or any other GnRH analogs.
Known or suspected pregnancy, and lactation.
Severe renal impairment.

What is the most important information I should know about CETRORELIX ACETATE FOR INJECTION?

CETRORELIX ACETATE FOR INJECTION should be prescribed by physicians who are experienced in fertility treatment. Before starting treatment with CETRORELIX ACETATE FOR INJECTION, pregnancy must be excluded.
Cases of hypersensitivity reactions, including anaphylactoid reactions with the first dose, have been reported during post-marketing surveillance. Special care should be taken in women with signs and symptoms of active allergic conditions or known history of allergic predisposition. Treatment with CETRORELIX ACETATE FOR INJECTION is not advised in women with severe allergic conditions.
Use of CETRORELIX ACETATE FOR INJECTION could result in fetal loss. It should not be used in pregnant women.
It is not known whether CETRORELIX ACETATE FOR INJECTION is excreted in human milk. Because the effects of CETRORELIX ACETATE FOR INJECTION on lactation and/or the breast-fed child have not been determined, CETRORELIX ACETATE FOR INJECTION should not be used by nursing mothers.
CETRORELIX ACETATE FOR INJECTION is not intended to be used in people aged 65 and over.

How do I take CETRORELIX ACETATE FOR INJECTION?

You can administer CETRORELIX ACETATE FOR INJECTION 0.25 mg yourself after receiving appropriate instruction from your doctor. To use CETRORELIX ACETATE FOR INJECTION 0.25 mg with the enclosed needles and pre-filled syringe:

Wash hands thoroughly with soap and water.
Flip off the plastic cover of the vial and wipe the aluminum ring and the rubber stopper with an alcohol swab.
Twist the injection needle with the yellow mark (20 gauge) on the pre-filled syringe.
Push the needle through the center of the rubber stopper of the vial and slowly inject the solvent into the vial.
Leaving the syringe in the vial, gently swirl the vial until the solution is clear and without residues. Avoid forming bubbles.
Draw the total contents of the vial into the syringe. If necessary, invert the vial and pull back the needle as far as needed to withdraw the entire contents of the vial.
Replace the needle with the yellow mark by the injection needle with the grey mark (27 gauge).
Invert the syringe and push the plunger until all air bubbles have been expelled.
Choose an injection site in the lower abdominal area, preferably around, but staying at least one inch away from the navel. Choose a different injection site each day to minimize local irritation. Use a second alcohol swab to clean the skin at the injection site and allow alcohol to dry. Gently pinch up the skin surrounding the site of injection.
Inject the prescribed dose as directed by your doctor, nurse, or pharmacist. Discard unused portion.
Use the syringe and needles only once. Dispose of the syringe and needles properly after use. If available, use a medical waste container for disposal.

What are the possible side effects of CETRORELIX ACETATE FOR INJECTION?

The most common adverse reactions occurring in ≥1% of people were ovarian hyperstimulation syndrome (3.5%), nausea (1.3%), and headache (1.1%).
Some people also experience reactions at the injection site, including redness, erythema, bruising, itching, swelling, and pruritis. These reactions usually went away quickly, were not severe, and lasted only a short time.

You are encouraged to report negative side effects of prescription drugs. To report SUSPECTED ADVERSE REACTIONS, contact Apotex at 1-800-706-5575 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatchM.

Please see full Prescribing Information.

^† If eligible, commercially insured patients may pay as little as $0^† out-of-pocket cost with the Cetrorelix Acetate Instant Savings Card toward each 30-day supply, and the program will pay up to $50 per 30-day supply not covered by primary insurance, up to $600 per calendar year. In the event the patient's cost-sharing obligation for CETRORELIX ACETATE FOR INJECTION under their health insurance is more than $50 per 30-day supply, the patient will be responsible for any cost-sharing beyond $50 for each 30-day supply. The Cetrorelix Acetate Instant Savings Program cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription.

^*Therapeutically equivalent to Cetrotide^® Injection for the labeled indication at the 0.25 mg dosage. Cetrotide^® is a registered trademark of EMD Serono, Inc.