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Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma Previously Treated Mantle Cell Lymphoma Waldenstrom's Macroglobulinemia Previously Treated Marginal Zone Lymphoma Previously Treated Chronic Graft Versus Host Disease

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Success! You can begin to use the IMBRUVICA® Copay Card immediately

Download your copay card information and present it along with a signed 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 Card

RxBIN: 610524 RxGRP: IMB57962 RxPCN: Loyalty ISSUER: 80840 ID: XXXXXXXXXX
Eligible Patients Pay as Little as $10

Eligible patients may pay as little as $0 per prescription of IMBRUVICA®. Rules and maximum limits apply. Patients currently using the IMBRUVICA® Copay Card are not eligible for retroactive billing or reimbursement of previous copays. 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. The IMBRUVICA® Copay program may be updated or discontinued at any time without notice.

PRC-09078 2/22

Pharmacyclics An AbbVie Company
Download Copay Card

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, 8AM-8PM 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, Medicaid, Medigap, VA, 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, 8AM-8PM ET, excluding holidays)

Pharmacyclics LLC, an AbbVie Company, reserves the right to rescind, revoke, or amend this offer at any time.

*IMBRUVICA® By Your Side patient support program is not intended to provide medical advice, replace prescribed treatment plans, or provide treatment or case management services. Patients are advised to talk to their healthcare provider and treatment team about any medical decisions and concerns they may have.

†By Your Side Ambassadors are provided by Janssen Biotech, Inc. and Pharmacyclics LLC, an AbbVie Company, and do not work under the direction of your healthcare professional (HCP) or give medical advice. They are trained to direct patients to their HCP for treatment-related advice, including further referrals.

RxBIN: 610524 RxGRP: IMB57962 RxPCN: Loyalty ISSUER: 80840 ID: XXXXXXXXXX

* Eligible patients may pay as little as $0 per prescription of IMBRUVICA®. Rules and maximum limits apply. Patients currently using the IMBRUVICA® Copay Card are not eligible for retroactive billing or reimbursement of previous copays. 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. The IMBRUVICA® Copay program may be updated or discontinued at any time without notice.

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

  • Patients currently using the IMBRUVICA® Copay Card are not eligible for retroactive billing or reimbursement of previous copays
  • The IMBRUVICA® Copay program may be updated or discontinued at any time without notice   
  • This offer is good for eligible patients on IMBRUVICA® who 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)
  • 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

IMPORTANT SIDE EFFECT INFORMATION

Before taking IMBRUVICA®, tell your healthcare provider about all of your medical conditions, including if you:

  • have had recent surgery or plan to have surgery. Your healthcare provider may stop IMBRUVICA® for any planned medical, surgical, or dental procedure.
  • have bleeding problems
  • have or had heart rhythm problems, smoke, or have a medical condition that increases your risk of heart disease, such as high blood pressure, high cholesterol, or diabetes
  • have an infection
  • have liver problems
  • are pregnant or plan to become pregnant. IMBRUVICA® can harm your unborn baby. If you are able to become pregnant, your healthcare provider will do a pregnancy test before starting treatment with IMBRUVICA®. Tell your healthcare provider if you are pregnant or think you may be pregnant during treatment with IMBRUVICA®. 
    • Females who are able to become pregnant should use effective birth control (contraception) during treatment with IMBRUVICA® and for 1 month after the last dose.
    • Males with female partners who are able to become pregnant should use effective birth control, such as condoms, during treatment with IMBRUVICA® and for 1 month after the last dose.
  • are breastfeeding or plan to breastfeed. Do not breastfeed during treatment with IMBRUVICA® and for 1 week after the last dose. 

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Taking IMBRUVICA® with certain other medicines may affect how IMBRUVICA® works and can cause side effects.

How should I take IMBRUVICA®?

  • Take IMBRUVICA® exactly as your healthcare provider tells you to take it.
  • Take IMBRUVICA® 1 time a day at about the same time each day.

    IMBRUVICA® comes as capsules, tablets, and oral suspension.

  • If your healthcare provider prescribes IMBRUVICA® capsules or tablets:
    • Swallow IMBRUVICA® capsules or tablets whole with a glass of water.
    • Do not open, break, or chew IMBRUVICA® capsules.
    • Do not cut, crush, or chew IMBRUVICA® tablets.
  • If your healthcare provider prescribes IMBRUVICA® oral suspension:
    • See the detailed Instructions for Use that comes with IMBRUVICA® oral suspension for information about the correct way to give a dose to your child. If you have questions about how to give IMBRUVICA® oral suspension, talk to your healthcare provider.
    • Do not use if the carton seal is broken or missing.
  • If you miss a dose of IMBRUVICA® take it as soon as you remember on the same day. Take your next dose of IMBRUVICA® at your regular time on the next day. Do not take extra doses of IMBRUVICA® to make up for a missed dose.
  • If you take too much IMBRUVICA® call your healthcare provider or go to the nearest hospital emergency room right away. 

What should I avoid while taking IMBRUVICA®?

  • You should not drink grapefruit juice, eat grapefruit, or eat Seville oranges (often used in marmalades) during treatment with IMBRUVICA®. These products may increase the amount of IMBRUVICA® in your blood.

What are the possible side effects of IMBRUVICA®?

IMBRUVICA® may cause serious side effects, including:

  • Bleeding problems (hemorrhage) are common during treatment with IMBRUVICA®, and can also be serious and may lead to death. Your risk of bleeding may increase if you are also taking a blood thinner medicine. Tell your healthcare provider if you have any signs of bleeding, including: blood in your stools or black stools (looks like tar), pink or brown urine, unexpected bleeding, or bleeding that is severe or that you cannot control, vomit blood or vomit looks like coffee grounds, cough up blood or blood clots, increased bruising, dizziness, weakness, confusion, change in your speech, or a headache that lasts a long time or severe headache.  
  • Infections can happen during treatment with IMBRUVICA®. These infections can be serious and may lead to death. Tell your healthcare provider right away if you have fever, chills, weakness, confusion, or other signs or symptoms of an infection during treatment with IMBRUVICA®.
  • Heart problems. Serious heart rhythm problems (ventricular arrhythmias, atrial fibrillation and atrial flutter), heart failure and death have happened in people treated with IMBRUVICA®, especially in people who have an infection, an increased risk for heart disease, or have had heart rhythm problems in the past. Your heart function will be checked before and during treatment with IMBRUVICA®. Tell your healthcare provider if you get any symptoms of heart problems, such as feeling as if your heart is beating fast and irregular, lightheadedness, dizziness, shortness of breath, swelling of the feet, ankles or legs, chest discomfort, or you faint. If you develop any of these symptoms, your healthcare provider may do tests to check your heart and may change your IMBRUVICA® dose.
  • High blood pressure (hypertension). New or worsening high blood pressure has happened in people treated with IMBRUVICA®. Your healthcare provider may start you on blood pressure medicine or change current medicines to treat your blood pressure.
  • Decrease in blood cell counts. Decreased blood counts (white blood cells, platelets, and red blood cells) are common with IMBRUVICA®, but can also be severe. Your healthcare provider should do monthly blood tests to check your blood counts.
  • Second primary cancers. New cancers have happened during treatment with IMBRUVICA®, including cancers of the skin or other organs.
  • Tumor lysis syndrome (TLS). TLS is caused by the fast breakdown of cancer cells. TLS can cause kidney failure and the need for dialysis treatment, abnormal heart rhythm, seizure, and sometimes death. Your healthcare provider may do blood tests to check you for TLS.

The most common side effects of IMBRUVICA® in adults with B-cell malignancies (MCL, CLL/SLL, WM and MZL) include:

  • diarrhea
  • tiredness
  • muscle and bone pain
  • rash
  • bruising

The most common side effects of IMBRUVICA® in adults or children 1 year of age and older with cGVHD include:

  • tiredness
  • low red blood cell count (anemia)
  • bruising
  • diarrhea
  • low platelet count
  • muscle and joint pain
  • fever
  • muscle spasms
  • mouth sores (stomatitis)
  • bleeding
  • nausea 
  • stomach pain 
  • pneumonia
  • headache

Diarrhea is a common side effect in people who take IMBRUVICA®. Drink plenty of fluids during treatment with IMBRUVICA® to help reduce your risk of losing too much fluid (dehydration) due to diarrhea. Tell your healthcare provider if you have diarrhea that does not go away.

These are not all the possible side effects of IMBRUVICA®. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

General information about the safe and effective use of IMBRUVICA®

Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use IMBRUVICA® for a condition for which it was not prescribed. Do not give IMBRUVICA® to other people, even if they have the same symptoms that you have. It may harm them. You can ask your pharmacist or healthcare provider for information about IMBRUVICA® that is written for health professionals.

Please see the full Important Product Information.

USES

What is IMBRUVICA® (ibrutinib)?

IMBRUVICA® (ibrutinib) is a prescription medicine used to treat:

  • Adults with mantle cell lymphoma (MCL) who have received at least one prior treatment.
  • Adults with chronic lymphocytic leukemia (CLL)/Small lymphocytic lymphoma (SLL).
  • Adults with chronic lymphocytic leukemia (CLL)/Small lymphocytic lymphoma (SLL) with 17p deletion.
  • Adults with Waldenström’s macroglobulinemia (WM).
  • Adults with marginal zone lymphoma (MZL) who require a medicine by mouth or injection (systemic therapy) and have received a certain type of prior treatment.
  • Adults and children 1 year of age and older with chronic graft versus host disease (cGVHD) after failure of 1 or more lines of systemic therapy.

It is not known if IMBRUVICA® is safe and effective in children under 1 year of age.

IMPORTANT SIDE EFFECT INFORMATION

USES

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