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Medicare and Patient Assistance

Patients receiving CIMERLI^® (ranibizumab-eqrn) injection with no insurance or who are insured with traditional Medicare fee-for-service (FFS) that demonstrate financial hardship and cannot afford their cost-sharing obligation may be eligible for patient assistance through the Patient Assistance Program (PAP). Patients with other government insurance, including Medicare Advantage, Medicare Part D, Fee-for-service Medicaid, Managed Medicaid, Veterans Affairs, Department of Defense, TRICARE, or any other insurance that is federally or state-funded are not eligible for Patient Assistance.

CIMERLI^® can be provided at no cost to eligible underinsured* patients with financial hardship* through the Patient Assistance Program (PAP).

Patient Eligibility Criteria (must meet all to qualify)

Patients Must

Be either: (a) uninsured; (b) functionally underinsured*; or (c) traditional Medicare FFS insured patient(s) that demonstrate financial hardship and cannot afford their cost-sharing obligation as evidenced by a signed attestation from their provider
Have an adjusted annual household income of ≤ 500% of Federal Poverty Level (FPL)
Complete and sign consent form and, when applicable, provide income documentation
Be under the care of a U.S. licensed provider, and receive CIMERLI^® in an established practice located in the U.S. incident to the prescribing physician’s professional services in the outpatient setting
Be a U.S. resident of any U.S. state or territory
Diagnosis and dosing are consistent with FDA-approved indication for CIMERLI^® (ranizumab-eqrn) injection
Not have any other financial support options
The patient must receive the drug in an outpatient setting by the physician or physician office
Providers: For insured patients I understand that the Coherus Solutions™ program does not provide free drug in the instance of an administrative error or a coverage restriction such as a step edit or others deemed as restrictions. For certain products where step edit may not be medically appropriate, and confirmed by the prescribing physician, the Coherus Solutions™ program may consider enrollment following one level of appeal. Must be enrolled in Coherus Solutions™
Providers requesting more than six (6) PAP fills for the same patient will be required to provide written attestation on business letterhead reaffirming continued PAP necessity (DX, patient therapy log, etc.)

*Functionally Underinsured means the patient does not have coverage for CIMERLI^® or any other ranibizumab product (biosimilar or reference).

Proactive Alternative Funding Notifications

Coherus Solutions™ may also be able to help your patients find financial support through charitable foundations. Patient Access Specialist can research alternative coverage options for your patients.

When funding becomes available, your practice will receive email notifications alerting you to available funds from charitable foundations.
Must be enrolled in Coherus Solutions™

Contact Coherus Solutions™ for detailed eligibility requirements at 1-844-483-3692 or apply online at www.coherussolutions.com

* Must meet all other eligibility requirements.
* To be considered functionally underinsured, the patient must not have coverage for CIMERLI^®.

If a patient received CIMERLI^™ within the past six months, they may be eligible for Retro PAP. Please contact Coherus Solutions™ at 1-844-483-3692 for additional information.

Retrospective Patient Assistance

Coherus Solutions™ may be able to assess patient eligibility for retrospective patient assistance. Please contact Coherus Solutions™ 1-844-483-3692 for additional information. Medicare patients are not eligible for retrospective patient assistance.

If eligible, the Patient Assistance Program only covers the costs of CIMERLI^® and does not cover any administration or office visit costs. Restrictions may apply and not valid where prohibited by law. Coherus may revise or terminate this program without notice at any time for any reason.

Enroll in the Patient Assistance Program

Terms and Conditions

Coherus’ Drug Copay Program and Administration Copay Program are different programs with unique eligibility for each. Patients must enroll separately as needed. To receive co-pay assistance for administration co-pay costs, the provider, patient, or caregiver must enroll eligible individual within 180 days after the date of service for which the subsidy is sought.

Participating patients, pharmacies, physician offices and hospitals may use Coherus’ patient services web portal or send completed enrollment forms to 1-877-226-6370 to enroll patients. Under the program, if a patient incurs a co-pay obligation for the administration of CIMERLI, and meets all eligibility requirements, Coherus shall subsidize the cost of administration up-to $1000 per calendar year. The program benefit will reset every January 1st. Re-enrollment in the program is required at regular intervals. Patients may participate in the program as long as patient re-enrolls as required by Coherus BioSciences and continues to meet all of the program’s eligibility requirements during participation in the program.. After reaching the maximum program benefit, the patient will be responsible for all remaining out-of-pocket expenses. The amount of the program’s benefits cannot exceed the patient’s out-of-pocket expenses for the cost of the drug or administration fees associated with CIMERLI.

The program is not valid if the costs are eligible to be reimbursed in their entirety by private insurance plans or other programs. The program is not valid for patients receiving assistance from any other third party, including charitable organizations, if assistance is for the same expenses covered by the programs. The administration assistance cannot be combined with any other rebate, free trial or similar offer for the medication or administration of the product unless otherwise permitted by Coherus. The program is not health insurance or a benefit plan.

All participants are responsible for reporting the receipt of all program benefits as required by any insurer or by law. The programs are only valid in the United States and U.S. Territories and otherwise void where prohibited by law, including in Minnesota, Rhode Island. *In Massachusetts special conditions apply. The injection administration copay may only be paid directly to the patient. Additional information may be required to facilitate payment directly to the patient. Program benefits may not be sold, purchased, traded or offered for sale.

The programs do not obligate use of any specific product or provider. Healthcare providers may not advertise or otherwise use the programs as a means of promoting their services or Coherus products to patients. Coherus reserves the right to rescind, revoke or amend the program without notice at any time.

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Medicare and Patient Assistance

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