Using Your Card

After You Have Enrolled, Here's How the Program Works

ACTEMRA intravenous (IV)

At the doctor's office, infusion center or hospital:

  • Receive your infusion.
  • Your doctor's office sends the ACTEMRA Co-pay Card Program a copy of the detailed Explanation of Benefits (EOB). You may also complete this step.
    • Your health plan automatically sends you the EOB after you receive your treatment
    • The EOB may be faxed to (800) 334-3030
  • The ACTEMRA Co-pay Card Program verifies your information. After verification of information and confirmation that program requirements are met, we load the co-pay amount minus the patient out-of-pocket responsibility.
  • You pay the out-of-pocket (OOP) drug costs for ACTEMRA with your card.
    • You pay the doctor's office, the hospital, the infusion center or your community/retail pharmacy, depending on where and how you receive your treatment

ACTEMRA subcutaneous (SC) injection

If your medicine comes from a specialty pharmacy (SP):

  • The SP will call you to collect your co-pay. When it does, give the SP the RxBIN and Member ID number listed on the card.
  • Your ACTEMRA SC is mailed to you.

If your medicine comes from a community/retail pharmacy:

  • When you are told your order is ready, bring the card to the community/retail pharmacy to pick up your ACTEMRA SC.
  • Give the card to the pharmacist at the community/retail pharmacy. He or she collects your co-pay and uses the card at the counter.

If your doctor, infusion center, hospital, SP or community/retail pharmacy cannot swipe your card:

  • Download the Check Request Form from the Downloadable Forms section.
  • Complete the Check Request Form and send it to Genentech, along with copies of the detailed EOB and payment receipt. These can be sent via:
    • Fax to (800) 334-3030
    • Mail to
      The ACTEMRA Co-pay Card Program
      100 Passaic Ave, Suite 245
      Fairfield, NJ 07004
  • A check is sent to the person named on Check Request Form. This takes 7 to 10 days.

Note: This program helps pay for drug costs described as "out-of-pocket," "co-pay," "co-insurance" or "uncovered expense" for ACTEMRA only. It does not pay for other costs related to the office visit or infusion.

To learn more, download these simple instructions.

Indication and Important Safety Information

ACTEMRA is a prescription medicine used to treat:

  • Adults with moderately to severely active rheumatoid arthritis (RA) after at least one other medicine called a disease modifying antirheumatic drug (DMARD) has been used and did not work well
  • Adults with giant cell arteritis (GCA)
  • Patients with active polyarticular juvenile idiopathic arthritis (PJIA) 2 years of age and older
  • Patients with active systemic juvenile idiopathic arthritis (SJIA) 2 years of age and older

It is not known if ACTEMRA is safe and effective in children with PJIA or SJIA under 2 years of age or in children with conditions other than PJIA or SJIA.

ACTEMRA can cause serious side effects

Serious Infections

ACTEMRA changes the way your immune system works. This can make you more likely to get infections or make any current infection worse. Some people have died from these infections. Your healthcare provider should test you for TB before starting and during treatment with ACTEMRA.

Do not take ACTEMRA if you are allergic to tocilizumab, or any of the ingredients in ACTEMRA.

ACTEMRA can cause other serious side effects. These include:

Tears (perforation) of the Stomach or Intestines
If you have diverticulitis (inflammation in parts of the large intestine), talk to your healthcare provider before taking ACTEMRA. Some people taking ACTEMRA may develop a hole in the wall of their stomach or intestines (also known as a perforation).

Changes in Blood Test Results
Your healthcare provider should do blood tests before you start receiving ACTEMRA. You should not receive ACTEMRA if your neutrophil and platelet counts are too low or your liver function test levels are too high. These may cause your healthcare provider to stop your ACTEMRA treatment for a time or change your dose.

Cancer
ACTEMRA may increase your risk of certain cancers by changing the way your immune system works.

Hepatitis B Infection
If you have or are a carrier of the hepatitis B virus (a virus that affects the liver), the virus may become active while you use ACTEMRA. Your healthcare provider may do blood tests before you start treatment with ACTEMRA and while you are using ACTEMRA.

Serious Allergic Reactions
Serious allergic reactions, including death, can happen with ACTEMRA. These reactions can happen with any infusion or injection of ACTEMRA, even if they did not occur with an earlier infusion or injection.

Nervous System Problems
While rare, Multiple Sclerosis has been diagnosed in people who take ACTEMRA.

The most common side effects of ACTEMRA include:

  • upper respiratory tract infections (common cold, sinus infections)
  • headache
  • increased blood pressure (hypertension)
  • injection site reactions

ACTEMRA & Pregnancy

Tell your healthcare provider if you are planning to become pregnant, are pregnant, plan to breast-feed, or are breast-feeding. If you are pregnant and taking ACTEMRA, join the pregnancy registry. To learn more, call 1-877-311-8972 or talk to your healthcare provider to register.

Tell your healthcare provider if you have any side effects. You may report side effects to FDA at 1-800-FDA-1088. You may also report side effects to Genentech at 1-888-835-2555.

Please see full Prescribing Information and the Medication Guide, including Serious Side Effects, for more Important Safety Information.