Financial Assistance

Patient support services and
programs to assist with access

Medicare and Patient Assistance

Patients receiving LOQTORZI 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.

LOQTORZI 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
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 LOQTORZI 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
Diagnosis and dosing are consistent with FDA-approved indication for LOQTORZI, or provider believes LOQTORZI is medically necessary based on the patient’s diagnosis
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 LOQTORZI.

Potential Alternative Funding Notifications

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

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 LOQTORZI 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

LOQTORZI CO-PAY SAVINGS SUPPORT PROGRAM TERMS AND CONDITIONS

If your patient would like to enroll in the co-pay program to receive co-pay assistance, you can help enroll them by:

To receive co-pay assistance for drug 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 fax completed enrollment forms to 1-877-226-6370 to enroll patients.

Under the LOQTORZI Co-Pay Savings Program, if a patient incurs a co-pay obligation for the cost of LOQTORZI, and meets all eligibility requirements, Coherus may provide co-pay assistance for up to $30,000 per calendar year.

The LOQTORZI Solutions™ Co-Pay Savings Program only covers the cost of the drug. It does not cover costs associated with drug administration.

The program benefits will reset every January 1st. Re-enrollment in the program is required at regular intervals. Patients may participate in the program as long as the patient re-enrolls as required by Coherus BioSciences and continues to meet all of the eligibility requirements for the program during participation in the program. After reaching the maximum benefit for either program, 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 LOQTORZI.

Patients must have commercial health insurance. Patients with any federal, state or government-funded healthcare coverage such as Medicare, Medicare Advantage, Medicare Part D, Veterans Affairs, Depart of Defense or Tricare are not eligible for the program.

The documentation required for claim submission, which can include, but is not limited to, an Explanation of Benefits (EOB) and claim form (e.g. CMS 1500), must be submitted within 365 days of the date that the primary claim was processed by the patient’s insurance to receive the co-pay savings benefit. Exceptions will not be made for claims submitted more than 365 days.

This co-pay assistance program is offered to, and intended for the sole benefit of, eligible patients and may not be utilized for the benefit of third parties, including, without limitation, third party payers, pharmacy benefit managers, or the agents of either. The program is not available if the costs are eligible to be reimbursed in their entirety by private insurance plans or other programs. The program is not available for patients receiving assistance from any other third party, including charitable organizations, if assistance is for the same expenses covered by the program. This program is not health insurance or a benefit plan. Patient and provider agree to not seek reimbursement for any or all of the benefit received by the patient through the co-pay savings program. Patient and provider are responsible for reporting receipt of Co-Pay Savings Program benefits to any insurer, health plan, or other third party who pays for reimburses any part of the drug cost, as may be required.

All participants are responsible for reporting the receipt of all program benefits as required by any insurer or by law. The program is only valid in the United States and US Territories and otherwise void where prohibited by law. Program benefits may not be sold, purchased, traded or offered for sale.

The program does 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.

Patient support services and
programs to assist with access

Medicare and Patient Assistance

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