Retrieve your Member ID
Complete the information below and receive a confirmation page immediately with your Copay Card information. If you would like a duplicate record of your card, enter your email address.
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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®.
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.
*Eligibility: Available to patients with commercial insurance coverage for IMBRUVICA® (ibrutinib) who meet eligibility criteria. This copay assistance program is not available to patients receiving prescription reimbursement under any federal, state, or government-funded insurance programs (for example, Medicare [including Part D], Medicare Advantage, Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs programs) or where prohibited by law. Offer subject to change or termination without notice. Restrictions, including monthly maximums, may apply. This is not health insurance. For full Terms and Conditions, visit https://www.imbruvica.com/imbruvica-by-your-side or call 1-888-YourSide (1-888-968-7743) for additional information. To learn about Pharmacyclics’ privacy practices and your privacy choices, visit https://www.pharmacyclics.com/privacy-policy.
IMBRUVICA® Copay Full Terms and Conditions
- Terms and Conditions apply. This benefit covers IMBRUVICA® (ibrutinib). Eligibility: Available to patients with commercial insurance coverage for IMBRUVICA® who meet eligibility criteria. Copay assistance program is not available to patients receiving reimbursement under any federal, state, or government-funded insurance programs (for example, Medicare [including Part D], Medicare Advantage, Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs programs) or where prohibited by law or by the patient’s health insurance provider. If at any time a patient begins receiving drug coverage under any such federal, state, or government-funded healthcare program, patient will no longer be able to use the IMBRUVICA® Copay Card and patient must call IMBRUVICA® at 1-855-332-6210 to stop participation. Patients residing in or receiving treatment in certain states may not be eligible. Patients may not seek reimbursement for value received from the IMBRUVICA® Copay Card program from any third-party payers. Offer subject to change or discontinuation without notice. Restrictions, including monthly maximums, may apply. Subject to all other terms and conditions, the maximum annual benefit that may be available solely for the patient’s benefit under the copay assistance program is $24,600 per calendar year. The actual application and use of the benefit available under the copay assistance program may vary on a monthly, quarterly, and/or annual basis depending on each individual patient’s plan of insurance and other prescription drug costs. This assistance offer is not health insurance. By redeeming this card, you acknowledge that you are an eligible patient and that you understand and agree to comply with the terms and conditions of this offer. To learn about Pharmacyclics’ privacy practices and your privacy choices, visit https://www.pharmacyclics.com/privacy-policy.
