FINANCIAL SUPPORT

Coherus’s LOQTORZI co-pay savings program may cover a portion of out-of-pocket costs associated with LOQTORZI for eligible patients with commercial insurance.

Under the program, assistance with drug co-pay costs is available up to $30,000 per calendar year. Eligible patients could pay as little as $0 per dose of LOQTORZI.

Patient eligibility criteria

• Be prescribed LOQTORZI for a medically appropriate purpose within 180 days of program enrollment
• Have commercial (private or nongovernmental) health insurance that covers the medication costs of LOQTORZI
• Over the age of 18 years old and a US resident
• Not covered by any federal, state, or government-funded healthcare program, such as Medicare, Medicare Advantage, Medicare Part D, Veterans Affairs, Department of Defense, or TRICARE
• Not seek reimbursement from any third party, including payers, charitable foundation, or flexible spending accounts (FSAs) or healthcare savings accounts (HSAs) for all or any of the benefit received by Coherus through the program
• If eligible, the co-pay savings program only covers the costs of LOQTORZI and does not cover any administration or office visit costs. Restrictions may apply and not valid where prohibited by law. Coherus may revise or terminate this program without notice at any time for any reason
• It is not valid for cash-paying patients

Financial assistance eligibility criteria

• Be either: (a) uninsured or (b) functionally underinsured*
• Have an adjusted annual household income of ≤500% of Federal Poverty Level (FPL)
• Complete and sign consent form and either provide income documentation or consent for Coherus to run a credit check
• Be under the care of a US licensed provider, and receive LOQTORZI in an established practice located in the United States incident to the prescribing physician’s professional services in the outpatient setting
• If eligible, the patient assistance program only covers the costs of LOQTORZI and does not cover any administration or office visit costs. Restrictions may apply and is not valid where prohibited by law. Coherus may revise or terminate this program without notice at any time for any reason
• Be a US resident
• Diagnosis and dosing are consistent with an FDA-approved indication for LOQTORZI, or provider believes LOQTORZI is medically necessary based on the patient's diagnosis
• Not have any other financial support options