Clovis Oncology Financial Assistance Programs, Terms and Conditions

Commercial Co-Pay Support Programs

One of the financial support programs Rubraca Connections provides is the Rubraca $0 Co-Pay Program. The following terms and conditions apply:

Rubraca $0 Co-Pay Program

  • Commercially insured patients are eligible to participate in the Rubraca $0 Co-Pay Program for as long as they are treated with Rubraca® (rucaparib) tablets and do not have government insurance. Patients can receive support of up to $24,000 per calendar year.

  • The Rubraca $0 Co-Pay Program is available for patients residing in the US, Puerto Rico, or
    US territories.

  • The card may only be used for co-pays associated with the payment for Rubraca. The card is limited to one patient and is not transferable and cannot be used retroactively for Rubraca prescriptions already purchased. No substitutions are permitted.

  • The card is not insurance and patients must have existing insurance that covers Rubraca.

  • Patient is responsible for reporting receipt of co-pay assistance to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the card, as may be required.

  • The card is valid only for patients with commercial insurance (includes healthcare exchanges) and not for patients who have government insurance to access Rubraca (Medicare, Medicaid, TRICARE, VA, DoD, or any other federal or state-funded healthcare benefit program).

  • The card is not valid for cash-paying patients who do not have commercial insurance.

  • The card is not valid where otherwise prohibited, taxed, or otherwise restricted.

  • The Rubraca $0 Co-Pay Program is valid for the calendar year and will automatically renew upon verification that the patient still meets the eligibility criteria.

  • The offer cannot be combined with other offers. The card has no cash value. No other purchase is necessary.

  • Clovis reserves the right to change the terms and conditions of the program or terminate the program without notice.

  • Patients may be enrolled by calling 1-844-779-7707 or by going online and providing valid commercial insurance and patient information (name and address).

Rubraca Connections Coverage Link

Rubraca Connections Coverage Link is a program designed to provide support to patients experiencing insurance coverage delays of 5 business days or more. Eligible patients receive 15 days’ supply of product for up to 90 days (3 months) during the pendency of insurance coverage investigations. The following terms and conditions apply:

  • Only patients who have a diagnosis consistent with the product package insert are eligible.

  • Patients must have commercial insurance or, if uninsured, be in the process of applying for commercial insurance. Government insurance–eligible beneficiaries, including Medicare, Medicaid, TRICARE, VA, DoD, or any other federal or state-funded healthcare benefit program, are not eligible to receive free product under this program.

  • Product may not be used for resale or shared with other patients.

  • Patients may contact 1-844-779-7707 to find out if they are eligible for this program.

  • Clovis reserves the right to change the terms and conditions of the program or terminate the program without notice.

Rubraca Connections Patient Assistance Program (PAP)

For patients who are uninsured or rendered uninsured (ie, patients who are unable to access Rubraca under their insurance), Rubraca Connections Access Specialists can help assess if there are Clovis clinical program coverage options available or determine if patients meet eligibility requirements to receive Rubraca at no cost from the Rubraca Connections PAP. Eligibility requirements include financial/income evaluation, US residency, uninsured or rendered uninsured. Patients and their prescribing physician must complete a Patient Assistance Program enrollment form in order for Rubraca Connections to assess eligibility for this program. Prescribers must attest on the form that the patient has a diagnosis consistent with the product package insert. Only patients who meet these diagnosis criteria and other eligibility criteria will be accepted into the program.