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Indication Statement:

Daily administration of Pulmozyme (dornase alfa) in conjunction with standard therapies is indicated in the management of cystic fibrosis (CF) patients to improve pulmonary function. In patients with an FVC ≥ 40% of predicted, daily administration of Pulmozyme has also been shown to reduce the risk of respiratory tract infections requiring parenteral antibiotics. Safety and efficacy of daily administration have not been demonstrated in patients for longer than twelve months.

Important Safety Information

  • Pulmozyme should not be used in patients with known hypersensitivity to dornase alfa, or any ingredients of the product.
  • Pulmozyme should be used in conjunction with standard therapies for CF.
  • Most common reported adverse events associated with the use of Pulmozyme include: voice alteration, pharyngitis, laryngitis, rash, chest pain, and conjunctivitis.

Pulmozyme Access Solutions®

Co-Pay Card Program

Reimbursement

The Pulmozyme® Access Solutions® offers the Pulmozyme Co-Pay Card Program to help qualified patients with the out-of-pocket (OOP) costs associated with their Pulmozyme prescription.

Eligible patients can receive up to $1500 per year, or up to $4000 per year with income verification. Patients are responsible for the first $30 per month, plus any amount not covered by the program.

Pulmozyme Access Solutions Copay Card

To be eligible, patients must meet the following criteria:

  • Have insurance coverage through commercial insurance (not a federal- or state-funded benefits program, such as Medicare, Medicaid, Medigap, VA, DoD or TRICARE)
  • Have a Pulmozyme co-pay of $30 or more per month
  • Be a Pulmozyme patient of 18 years of age or older, or a legal guardian over the age of 18
  • Cannot be residing or receiving treatment in Massachusetts
  • Cannot be participating in the Genentech® Access to Care Foundation

How the Co-Pay Card process works

We will provide your office with a display housing the Pulmozyme Access Solutions Co-Pay Cards and accompanying patient brochures. Your patient will be able to activate the card by calling the phone number or visiting the website listed on the front of the card. They will be asked to confirm residency, annual income, insurance status, card ID, date of birth, last 4 digits of his or her Social Security Number, and contact information.

To use the card, your patient must present it to the pharmacist along with their Pulmozyme prescription. The co-pay assistance will be automatically applied at each refill. The card must be used within 1 year of activation.

To talk to a Specialist about the Pulmozyme Access Solutions Co-Pay Card Program, please call 1-877-PZ4URCF (1-877-794-8723) or visit PulmozymeCoPayCard.com for more information.

Please note: As a healthcare provider, you might be obligated under your contracts with payers to disclose acceptance of funds provided through the Pulmozyme Access Solutions Co-Pay Card Program as payment for products dispensed to your patient. You may not advertise or otherwise use the Pulmozyme Access Solutions Co-Pay Card program as a means of promoting your services or Genentech USA, Inc. No person or entity may seek reimbursement from any third-party payer for any amount provided using the Pulmozyme Access Solutions Co-Pay Card Program.

Genentech reserves the right to deny payment under the Pulmozyme Access Solutions Co-Pay Card Program to anyone deemed ineligible in accordance with the stated program criteria.

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