Join the CellCept® $15 Co-pay Card program

If you have commercial insurance, the CellCept® $15 Co-pay Card can help reduce your out-of-pocket costs to $15 per monthly co-pay, regardless of your income level. If you’ve been prescribed brand-name CellCept, complete the form below to find out if you are eligible and join the program.

Do you already have a co-pay card? You need to activate your card before using it. Every 12 months, you need to renew your card to verify that you are still eligible.

Step 1 of 2: Find out if you’re eligible

1. Are you 18 years of age or older?

You must be 18 years or older to complete this form. Please have a parent or a legally authorized person who is at least 18 years of age complete the enrollment.

If you believe you have received this message in error, please call 1-855-SAV-CELL (1-855-728-2355) to speak with an agent.

2. For what has brand-name CellCept been prescribed for?

The patient must be prescribed brand-name CellCept for an FDA-approved indication to use the co-pay program.

If you believe you have received this message in error, please call 1-855-SAV-CELL (1-855-728-2355) to speak with an agent.

3. Does the patient have commercial insurance? (Like the type you get through an employer or directly from an insurance company. Healthcare exchange plans that are offered through the Affordable Care Act are considered commercial insurance.)

The patient is not eligible for the program. It is intended for patients with commercial insurance. Click here to find out about additional assistance that the patient may be eligible to receive.

If you believe you have received this message in error, please call 1-855-SAV-CELL (1-855-728-2355) to speak with an agent.

4. What is the patient’s state (or territory) of residence?

Select
  • Not a United States resident
  • Alabama
  • Alaska
  • American Samoa
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Guam
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Northern Mariana Islands
  • Ohio
  • Oklahoma
  • Oregon
  • Pennsylvania
  • Puerto Rico
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virgin Islands
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming

The patient is not eligible for the program. The program is only valid for residents of the United States and Puerto Rico. The program is not valid for residents of Massachusetts. Click here to find out about additional assistance that the patient may be eligible to receive.

If you believe you have received this message in error, please call 1-855-SAV-CELL (1-855-728-2355) to speak with an agent.

5. Is the patient receiving free drug assistance through the Genentech® Access to Care Foundation (GATCF) or any other charitable organization?

The patient is not eligible for the program.

If you believe you have received this message in error, please call 1-855-SAV-CELL (1-855-728-2355) to speak with an agent.

6. Is the patient a government beneficiary and/or enrolled in any state- or federally funded healthcare program, including but not limited to all Medicare, Medicaid, Medigap, VA, DoD, or TRICARE? We may contact the patient by phone or mail periodically in order to verify that the patient's eligibility for the program has not changed.

The patient is not eligible for the program. The card cannot be used with Medicare, Medicaid, or any other federal or state program. Click here to find out about additional assistance that the patient may be eligible to receive.

If you believe you have received this message in error, please call 1-855-SAV-CELL (1-855-728-2355) to speak with an agent.

Step 2 of 2: Patient information

An error has occurred. Please call 1-855-SAV-CELL (1-855-728-2355) to speak with an agent.

*Required fields







Select
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Pennsylvania
  • Puerto Rico
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming


How did you hear about the program?

Select
  • Healthcare Provider
  • Transplant Coordinator/Team
  • CellCept® Co-pay Card Brochure
  • Online Search
  • CellCept.com
  • Email
  • Pharmacy
  • In-office Poster
  • Online Ads
  • Other

Are you the patient?*

Enroller information







Select
  • Alabama
  • Alaska
  • American Samoa
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Guam
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Northern Mariana Islands
  • Ohio
  • Oklahoma
  • Oregon
  • Pennsylvania
  • Puerto Rico
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virgin Islands
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming



Terms and Conditions

*The patient information disclosed during this enrollment, including name, email address, mailing address, and phone number, will be shared with Genentech, the sponsor of the card. In addition, information shared by the patient’s pharmacy/physician, such as the date the patient filled the prescription, the date the medication was administered by the patient’s physician (if applicable), and the amount that the patient will be reimbursed by Genentech, will be shared with Genentech, the sponsor of this card. The patient agrees to be contacted by phone, mail, or email with the information and/or materials about the patient’s Genentech CellCept® $15 Co-pay Card. For more information, please see the Genentech Privacy Policy at www.gene.com.

You must give your consent (or the patient must give his or her consent) to enroll in the program.

If you believe you have received this message in error, please call 1-855-SAV-CELL (1-855-728-2355) to speak with an agent.

*I have read and agreed (or the patient has read and agreed) to the terms and conditions of the CellCept® $15 Co-pay Card program.

You must read and agree (or the patient must read and agree) to the terms and conditions in order to enroll in the program.

If you believe you have received this message in error, please call 1-855-SAV-CELL (1-855-728-2355) to speak with an agent.

Patient Consent

*I give my consent (or I have the patient’s consent) to enroll in the CellCept® $15 Co-pay Card program.

You must give your consent (or the patient must give his or her consent) to enroll in the program.

If you believe you have received this message in error, please call 1-855-SAV-CELL (1-855-728-2355) to speak with an agent.

Success!

You are signed up for the CellCept® $15 Co-pay Card program

A printed CellCept® Co-pay Card will arrive by mail in 5 to 7 business days. But you can start benefiting today. Simply click the button below and print out a temporary version of the card.

How to use the card

You should present the card to the pharmacist:

  • If your pharmacy can store the co-pay card information, you may not need to present the card each month
  • If you use a specialty or mail order pharmacy, you should provide the co-pay card details over the phone

Learn more about using the CellCept® $15 Co-pay Card.

Success!

The patient is signed up for the CellCept® $15 Co-pay Card program

A printed CellCept® Co-pay Card will arrive by mail in 5 to 7 business days. But the patient can start benefiting today. Simply click the button below and print out a temporary version of the card.

How to use the card

The patient should present the card to the pharmacist:

  • If the patient’s pharmacy can store the co-pay card information, he or she may not need to present the card each month
  • If the patient uses a specialty or mail order pharmacy, he or she should provide the co-pay card details over the phone

Learn more about using the CellCept® $15 Co-pay Card.