Welcome to the Pulmozyme Co-Pay Card Program. This site will walk you through the steps required to enroll the patient in the program and activate the card. Eligible patients can enroll in the Co-Pay Card Program and receive help with their monthly insurance co-payments. If the patient has already completed the activation process and has lost their card, click on "Replace Card" below.
Please note that the patient must be 18 years of age or older to enroll themself in the program. If the patient is under 18, they must have a Legally Authorized Person complete their enrollment.
If the patient is currently enrolled in the program and the co-pay card has expired or the 12-month activation period for the co-pay card is about to expire, please click on "Re-Enroll" to complete the re-enrollment process.

For new patients:

For currently enrolled patients:

Please contact us at 1-877-PZ4URCF
(1-877-794-8723)
(8:00 AM to 8:00 PM ET, Monday to Friday)
if you have questions regarding the program

For more information about Pulmozyme, please visit:
www.pulmozyme.com

Terms and Conditions:

By using the Pulmozyme Co-Pay Card Program, the patient acknowledges and confirms that at the time of usage, (s)he is currently eligible and meet the criteria set forth in the terms and conditions described.

This Co-Pay Card is valid ONLY for patients with commercial (private or non-governmental) insurance who are taking the medication for an FDA approved indication. Patients using Medicare, Medicaid or any other government funded program to pay for their medications are not eligible. Patients who start utilizing their Government coverage during their enrollment period will no longer be eligible for the program.

This Co-Pay Card Program is not health insurance or a benefit plan. Distribution or use of the Co-Pay Card does not obligate use or continuing use of any specific product or provider. Patient or guardian is responsible for reporting the receipt of all Co-Pay Card Program benefits or reimbursement received, to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the Co-Pay Card Program, as may be required.

The Co-Pay Card is not valid for medications the patient receives for free or that are eligible to be reimbursed by private insurance plans or other healthcare or pharmaceutical assistance programs (such as: Genentech® Access to Care Foundation [GATCF] or any other charitable organization) that reimburse the patient in part or for the entire cost of his/her Genentech medication. Patient, guardian, pharmacist, prescriber and any other person using the Co-Pay Card agree not to seek reimbursement for all or any part of the benefit received by the recipient through the offer.

The Co-Pay Card will be accepted by participating pharmacies, physician offices or hospitals. To qualify for the benefits of this Co-Pay Card Program, the patient may be required to pay out-of-pocket expenses for each treatment. Once enrolled, this Co-Pay Card Program will not honor claims with date of service or medication dispensing that precede program enrollment by more than 120 days. This Co-Pay Card is only available with a valid prescription and cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription. Use of this Co-Pay Card must be consistent with all relevant health insurance requirements and payer agreements. Participating patients, pharmacies, physician offices and hospitals are obligated to inform third-party payers about the use of the Co-Pay Card as provided for under the applicable insurance or as otherwise required by contract or law. The Co-Pay Card may not be sold, purchased, traded or offered for sale, purchase or trade. The Co-Pay Card is limited to 1 per person during this offering period and is not transferable. This program expires within 12 months from enrollment. This program is not valid where prohibited by law. For Massachusetts' residents, the Co-Pay Card is not valid for any prescription drug that has an AB rated generic equivalent as determined by the United States Food and Drug Administration. For Massachusetts' residents, this program shall expire on or before July 1, 2019.

The patient or their guardian must be 18 years or older to receive Co-Pay Card Program assistance. This Co-Pay Card Program is: (1) Void if the card is reproduced; (2) Void where prohibited by law; (3) only valid in the United States and Puerto Rico; and (4) only valid for Genentech products. Healthcare providers may not advertise or otherwise use the program as a means of promoting their services or Genentech's products to patients. Genentech, Inc. reserves the right to rescind, revoke, or amend the program without notice at any time.

Indication and Usage

Pulmozyme® (dornase alfa) is indicated for daily administration along with standard therapies for the management of cystic fibrosis (CF) patients to improve pulmonary function.

In CF patients with an FVC ≥ 40% of predicted, daily administration of Pulmozyme has also been shown to reduce the risk of respiratory tract infections requiring injectable antibiotics.

Important Safety Information

Pulmozyme should not be used in patients who are allergic to any of its ingredients.

Patients may experience the following when using Pulmozyme: change in or loss of their voice, discomfort in the throat, rash, chest pain, red watery eyes, runny nose, lowering of lung function, fever, indigestion, and shortness of breath. There have been no reports of severe allergic reactions caused by the administration of Pulmozyme. Mild to moderate hives and mild skin rash have been observed and have been short‑lived.

Pediatric Use

The safety and effectiveness of Pulmozyme have been established in patients 5 years of age and older. While clinical trial data are limited in patients younger than 5 years of age, the use of Pulmozyme should be considered for pediatric CF patients who may experience potential benefit in lung function or who may be at risk of respiratory tract infection.

The safety of Pulmozyme given by daily inhalation for 2 weeks has been studied using 98 CF patients with 65 of them aged 3 months to <5 years (younger group) and 33 aged 5 years to <10 years (older group). The PARI BABY™ reusable nebulizer (which uses a face mask instead of a mouthpiece) was used in patients who were unable to show that they could breathe in or out using their mouth throughout the entire treatment period. Overall, the kind of side effects observed in children was similar to those seen in larger trials in older patients.

You are encouraged to report side effects to Genentech and the FDA. You may report side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at 1-888-835-2555.

For further information, please see the full Pulmozyme Prescribing Information. If you have questions, please discuss them with your CF Care Team.

PUL/061515/0108(3)