Manufacturer Co-Pay Assistance Card Guide By Disease State

Co-pay cards are not valid for prescriptions covered by Medicare, Medicaid, or any federal/state funded program.
Click Medication For Printable Cards: You will have to actually print the card for each patient 
Cards that are not printable can be obtained by calling the 800 number listed below

Hepatitis C Medications

HARVONI                              Up to a maximum of 25%, call 855-769-7284 (Patient Activation Required)              
INCIVEK ™                           Up to $10,000 per year, call 855-837-8394 (Patient Activation Required)
OLYSIO                                 Up to $50,000 per year, call 855-565-9746 (Patient Activation Required)
Pegasys                                Up to $200 per month, call 888-202-9939 (Patient Activation Required)
Ribasphere RibaPak             Up to $150 per month
SOVALDI                              Up to a maximum of 25%, call 855-769-7284 (Patient Activation Required)

Solid Organ Transplant Medications

ASTAGRAF XL®                  Up to $3000 annually, call 866-790-7659 (Patient Activation Required)
CellCept®                             Up to $5,000 per year, call 855-728-2355 (Patient Activation Required)
MYFORTIC®                        Up to $600 per 30-day supply, call 877-952-1000 (Patient Activation Required)
NEORAL®                            Up to $600 per 30-day supply, call 877-952-1000 (Patient Activation Required)
PROGRAF®                         Up to $3000 annually, call 866-790-7659 (Patient Activation Required)
Sandimmune®                      Up to $600 per 30-day supply, call 877-952-1000 (Patient Activation Required)
Valcyte®                               Up to $5,000 per year, call 877-698-2549 (Patient Activation Required)  
ZORTRESS®                        Up to $600 per 30-day supply, call 877-952-1000 (Patient Activation Required)

Oncology Medications

AFINITOR®                          Up to $6350 per month, call 877-577-7756 (Patient Activation Required)
Avastin®                               Up to $25,000 per year, call 855-692-6729 (Patient Activation Required)
COTELLIC™                         Up to $25,000 per year, call 855-692-6729 (Patient Activation Required)
EXJADE®                             Up to $20,000 per year, call 888-903-7277 (Patient Activation Required)
FARYDAK®                          Up to $25,000 per year, call 877-577-7756 (Patient Activation Required)
FEMARA®                            Up to $100 per month, call 877-577-7756 (Patient Activation Required)
GLEEVEC®                          Up to $30,000 per year, call 877-577-7756 (Patient Activation Required)
Herceptin®                            Up to $25,000 per year, call 855-692-6729 (Patient Activation Required)
JADENU™                            Up to $20,000 per year, call 877-577-7756 (Patient Activation Required)
MEKINIST®                          Up to $15,000 per year, call 877-577-7756 (Patient Activation Required)
NEXAVAR                             Up to $16,000 per year, call 866-639-2827 (Patient Activation Required)
ODOMZO®                           Up to $15,000 per year, call 877-577-7756 (Patient Activation Required)
PERJETA®                           Up to $25,000 per year, call 855-692-6729 (Patient Activation Required)
POMALYST®                        Up to $10,000 per year, call 800-931-8691 (Patient Activation Required)
PROMACTA®                       Up to $15,000 per year, call 877-577-7756 (Patient Activation Required)
REVLIMID®                          Up to $10,000 per year, call 800-931-8691 (Patient Activation Required)
RITUXAN®                           Up to $25,000 per year, call 855-692-6729 (Patient Activation Required)
Sandostatin® LAR Depot      Up to $15,000 per year, call 877-577-7756 (Patient Activation Required)
TAFINLAR®                          Up to $15,000 per year, call 877-577-7756 (Patient Activation Required)
Tarceva®                              Up to $25,000 per year, call 855-692-6729 (Patient Activation Required)
TASIGNA®                           Up to $32,000 per year, call 877-887-9303 (Patient Activation Required)
THALOMID®                         Up to $10,000 per year, call 800-931-8691 (Patient Activation Required)
TYKERB®                             Up to $15,000 per year, call 877-577-7756 (Patient Activation Required)
VOTRIENT®                         Up to $15,000 per year, call 877-577-7756 (Patient Activation Required)
ZELBORAF®                        Up to $25,000 per year, call 855-692-6729 (Patient Activation Required)
ZYKADIA™                           Up to $36,000 per year, call 877-577-7756 (Patient Activation Required)
ZYTIGA®                              Up to $12,000 per year, call 855-998-4421 (Patient Activation Required)
 

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