FINANCIAL SUPPORT IS AVAILABLE

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
• Other restrictions apply; see Terms and Conditions at LOQTORZISolutions.com
• It is not valid for cash-paying patients or where prohibited by law
• LOQTORZI™ Co-Pay Savings Program is subject to change or discontinuation without notice

Financial assistance eligibility criteria

• Be either: (a) uninsured; (b) functionally underinsured*; or (c) traditional Medicare Fee-for-Service (FFS) insured patient(s) who demonstrate financial hardship and cannot afford their cost-sharing obligation as evidenced by a signed attestation from their provider
• Have an adjusted annual household income of ≤500% of Federal Poverty Level (FPL)
• Complete and sign consent form and, when applicable, provide income documentation
• 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
• LOQTORZI Solutions™ may be able to assess patient eligibility for retrospective patient assistance. Please contact LOQTORZI Solutions™ at 1-844-483-3692 for additional information. Medicare patients are not eligible for retrospective patient assistance
• 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 the program 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 is for an FDA-approved indication of LOQTORZI™
• Not have any other financial support options
• The patient must receive the drug in an outpatient setting by the physician or physician office