Sign Up for Support with IMBRUVICA® By Your Side
Sign up for the IMBRUVICA® By Your Side patient support program and begin receiving helpful information and resources about treatment with IMBRUVICA®. With Patient Education and Cost and Coverage support available, IMBRUVICA® By Your Side has something for everyone.
Sign Up for Support with
IMBRUVICA® By Your Side
Sign up for the IMBRUVICA® By Your Side patient support program and begin receiving helpful information and resources about treatment with IMBRUVICA®. With Patient Education and Cost and Coverage support available, IMBRUVICA® By Your Side has something for everyone.
You can sign up for By Your Side patient support using this short form or by calling 1-888-YourSide (1-888-968-7743).
What happens next?
Once you're signed up, your dedicated By Your Side Ambassador will call you within one business day. From that first call, they will:
Provide one-on-one support throughout your treatment journey
Connect you to an Insurance Specialist who can provide helpful information about cost and coverage
Send you specially selected education and support materials
To enroll your patient, please click here and complete the enrollment form with your patient's consent.
Sign up here
Terms and Conditions Apply: The IMBRUVICA® Copay Card applies to commercial insurance copay, deductible, and coinsurance medication costs for IMBRUVICA®. This program cannot be used with any state or other federally-funded prescription insurance program including, but not limited to Medicare Part D, Medicare Advantage Plan, Medicaid, Medigap, VA or DOD or TRICARE, or any other pharmaceutical assistance programs, or where prohibited by law.
Success! Welcome to the IMBRUVICA® By Your Side Support Program
Here’s what you can expect next.
- You’ll get a phone call from your own, dedicated IMBRUVICA® By Your Side Ambassador. This call may come from a number you don’t recognize.
- You’ll also start receiving email communications from the IMBRUVICA® By Your Side support program. Keep an eye on your inbox for your first email, coming soon!
Keep an eye on your inbox for your first email, coming soon!
Here’s what you can expect next.
- You’ll get a phone call from your own, dedicated IMBRUVICA® By Your Side Ambassador. This call may come from a number you don’t recognize.
- You’ll also start receiving email communications from the IMBRUVICA® By Your Side support program. Keep an eye on your inbox for your first email, coming soon!
Keep an eye on your inbox for your first email, coming soon!
You’ve successfully enrolled in the IMBRUVICA® By Your Side patient support program, but your IMBRUVICA® Copay Card application has been rejected. If you feel like this is an error, please call 1-888-YourSide (1-888-968-7743).
Here’s what you can expect next.
- You’ll get a phone call from your own, dedicated IMBRUVICA® By Your Side Ambassador. This call may come from a number you don’t recognize.
- You’ll also start receiving email communications from the IMBRUVICA® By Your Side support program.
Keep an eye on your inbox for your first email, coming soon!
You can also begin to use the IMBRUVICA® Copay Card immediately.
Your official copay card has been sent to you based on your preferred method of communication. In the meantime, you can download this page and present it along with a valid prescription for IMBRUVICA® to your pharmacist for an instant savings that can be applied toward out-of-pocket expenses on your prescription for IMBRUVICA®.
Copay Program
Eligible patients may pay as little as $10 per prescription of IMBRUVICA® until the maximum limit of $24,600 per calendar year is reached. The IMBRUVICA® Copay Card is available to patients with commercial prescription coverage for IMBRUVICA® who meet eligibility criteria. The IMBRUVICA® Copay Card cannot be used by patients receiving prescription reimbursement under any federal, state, or government-funded insurance programs, including Medicare Part D, Medicare Advantage Plan, Medicaid, Medigap, VA, DOD, and TRICARE, or where prohibited by law or the patient’s health insurance provider.
To the Patient: You must present this card to the pharmacist along with your prescription to participate in this program. If you have any questions regarding your eligibility or benefits, or if you wish to discontinue your participation, call the IMBRUVICA® By Your Side patient support program at 1-888-YourSide (1-888-968-7743), (Monday - Friday, 8:00 AM - 8:00 PM ET). When you use this card, you are certifying that you understand the program rules, regulations, and terms and conditions. You are not eligible if prescriptions are paid by any state or other federally funded programs, including, but not limited to Medicare Part D, Medicare Advantage Plan, or Medicaid, Medigap, VA or DOD or TRICARE, or where prohibited by law; and you will otherwise comply with the terms above.
To the Pharmacist: When you use this card, you are certifying that you have not submitted and will not submit a claim for reimbursement under any federal, state or other governmental programs for this prescription.
- Submit transaction to RxC Acquisition Company d/b/a RxCrossroads by McKesson using BIN #610524
- If primary commercial prescription insurance exists, input card information as secondary coverage and transmit using the COB segment of the NCPDP transaction. Applicable discounts will be displayed in the transaction response
- Acceptance of this card and your submission of claims for the IMBRUVICA® Copay Program are subject to the LoyaltyScript® program Terms and Conditions posted at www.mckesson.com/mprstnc
- The IMBRUVICA® Copay Card cannot be used by patients receiving prescription reimbursement under any federal, state, or government-funded insurance programs, including Medicare Part D, Medicare Advantage Plan, Medicaid, Medigap, VA, DOD, and TRICARE, or where prohibited by law or the patient’s health insurance provider
- The LoyaltyScript® card is not valid for use with any other prescription drug discount or cash cards for IMBRUVICA®. Claims submitted utilizing the program are subject to audit or validation
- For questions regarding setup, claim transmission, patient eligibility or other issues, call the LoyaltyScript® for IMBRUVICA® program at 1-855-332-6211 (Monday - Friday, 8:00 AM - 8:00 PM ET, excluding holidays)
Pharmacyclics LLC, an AbbVie Company, reserves the right to rescind, revoke or amend this offer at any time.
To the Patient: You must present this card to the pharmacist along with your prescription to participate in this program. If you have any questions regarding your eligibility or benefits, or if you wish to discontinue your participation, call the IMBRUVICA® By Your Side patient support program at 1-888-YourSide (1-888-968-7743), (Monday - Friday, 8:00 AM - 8:00 PM ET). When you use this card, you are certifying that you understand the program rules, regulations, and terms and conditions. You are not eligible if prescriptions are paid by any state or other federally funded programs, including, but not limited to Medicare Part D, Medicare Advantage Plan, or Medicaid, Medigap, VA or DOD or TRICARE, or where prohibited by law; and you will otherwise comply with the terms above.
To the Pharmacist: When you use this card, you are certifying that you have not submitted and will not submit a claim for reimbursement under any federal, state or other governmental programs for this prescription.
- Submit transaction to RxC Acquisition Company d/b/a RxCrossroads by McKesson using BIN #610524
- If primary commercial prescription insurance exists, input card information as secondary coverage and transmit using the COB segment of the NCPDP transaction. Applicable discounts will be displayed in the transaction response
- Acceptance of this card and your submission of claims for the IMBRUVICA® Copay Program are subject to the LoyaltyScript® program Terms and Conditions posted at www.mckesson.com/mprstnc
- The IMBRUVICA® Copay Card cannot be used by patients receiving prescription reimbursement under any federal, state, or government-funded insurance programs, including Medicare Part D, Medicare Advantage Plan, Medicaid, Medigap, VA, DOD, and TRICARE, or where prohibited by law or the patient’s health insurance provider
- The LoyaltyScript® card is not valid for use with any other prescription drug discount or cash cards for IMBRUVICA®. Claims submitted utilizing the program are subject to audit or validation
- For questions regarding setup, claim transmission, patient eligibility or other issues, call the LoyaltyScript® for IMBRUVICA® program at 1-855-332-6211 (Monday - Friday, 8:00 AM - 8:00 PM ET, excluding holidays)
Pharmacyclics LLC, an AbbVie Company, reserves the right to rescind, revoke or amend this offer at any time.
By using this copay card, the patient understands and agrees to comply with these eligibility requirements and terms of use:
Eligibility
- Covered by commercial or private insurance
- Reside in the United States (including Puerto Rico, US Virgin Islands, Guam)
- The IMBRUVICA® Copay Card cannot be used by patients receiving prescription reimbursement under any federal, state, or government-funded insurance programs, including Medicare Part D, Medicare Advantage Plan, Medicaid, Medigap, VA, DOD, and TRICARE, or where prohibited by law or the patient’s health insurance provider
Terms and Conditions of the IMBRUVICA® Copay Card
- This offer is good for eligible patients on IMBRUVICA® who are 18 years of age or older, are residents of the United States, Puerto Rico, US Virgin Islands or Guam, and have a valid prescription for IMBRUVICA®
- This program is not available to individuals enrolled in federal or state subsidized healthcare programs that cover prescription drugs, including Medicare, such as Medicare Part D prescription drug benefit, Medicare Advantage, Medicaid, TRICARE, or any other federal or state healthcare plan, including pharmaceutical assistance programs. Participants certify that they will not seek reimbursement or compensation from any of these programs, including a flexible spending account, a Health Savings Account (HSA), or a Health Reimbursement Account (HRA)
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Individuals who become enrolled in a federal or state subsidized healthcare program that covers prescription drugs at any point after enrolling in the IMBRUVICA® Copay Card program must immediately stop using their IMBRUVICA® Copay Card and call 855-332-6210 to inform RxCrossroads of their change in status. Individuals are no longer eligible for the IMBRUVICA® Copay Card program effective as of the date of their enrollment in the federal or state subsidized healthcare program
- This offer may not be combined with any other coupon, discount, prescription savings program card, free trial or other offer
- Patients are not required to re-enroll in the program. After the initial enrollment, patients will be automatically re-enrolled for each subsequent year in the program, provided that they continue to meet eligibility criteria for the program
- Before you activate your membership in this program, it is important that you understand that you will be asked to provide personal information that may include identifiers such as your name, address, phone number, and email address, and information related to your insurance, health, and treatment. This information will be used by Pharmacyclics LLC, the manufacturer of IMBRUVICA®, and companies that work with Pharmacyclics LLC, including vendors and affiliates, to provide benefits to you related to the activation and use of your IMBRUVICA® Copay Card, and for internal business purposes including research and analytics. The information you provide will be shared with our vendors, collaborators, and affiliates and as required by law. For more information about the categories of personal information collected by Pharmacyclics and the purposes for which we use personal information, please visit www.pharmacyclics.com and click on the privacy policy link
- The IMBRUVICA® Copay Card will be accepted only at participating pharmacies
- The selling, purchasing, trading, or counterfeiting of this program information is prohibited
- Pharmacyclics LLC reserves the right to rescind, revoke, or amend this offer without notice at any time. Void where prohibited, taxed, or otherwise restricted by law