All new enrollments into the ACTEMRA and Rituxan Immunology Co-pay Programs will no longer receive a physical co-pay card. You can access the payment processing information in your provider portal.
Patients already using the ACTEMRA and Rituxan Immunology Co-pay Programs may continue to use their physical co-pay cards until the card’s expiration date.
For more information, please call the Help Desk at (855) RA-COPAY (855-722-6729).
The information contained in this section of the site is intended for US health care professionals only. Click “OK” if you are a health care professional or specialty pharmacy representative.
The information contained in this section of the site is intended for specialty pharmacy representatives only. Click “OK” if you are a health care professional or specialty pharmacy representative.
The ACTEMRA and Rituxan Immunology Co-pay Program for drug assistance and the Rituxan Immunology Co-pay Program for infusion assistance may be used in a community practice, infusion center or hospital. For drug assistance only, the program may also be used with specialty pharmacies.
Participating practices, institutions or specialty pharmacies must complete a one-time registration so they may process ACTEMRA and Rituxan Immunology Co-pay Program payments. To register, call (855) RA-COPAY (855-722-6729).
Enrolled patients will receive a welcome letter with their member information for their drug and/or infusion costs.*
View the ACTEMRA and Rituxan Immunology Co-pay Portal User Guide for information on how to process payments on RACopay.com.
 | Administer ACTEMRA or Rituxan treatment. |
 | Fax a copy of the detailed explanation of benefits (EOB)† to (800) 334-3030 or upload it to RACopay.com/hcp. The requirements for reimbursement must include:
If the EOB does not include any of the above items, additional documentation may be required to process the request. |
 | The ACTEMRA and Rituxan Immunology Co-pay Program verifies the patient's information and notifies your practice when the account is loaded with the proper amount. |
 | Collect the patient's $5 co-pay for ACTEMRA or Rituxan drug costs and/or $5 for Rituxan infusion costs, then collect the rest of the patient's out-of-pocket costs from drug and/or infusion using the program. |
*Multiple payment methods from the ACTEMRA and Rituxan Immunology Co-pay Program are available. They include the process shown here, as well as, reimbursement by check and electronic funds transfer. For more information, please contact the ACTEMRA and Rituxan Immunology Co-pay Program help desk at (855) RA-COPAY (855-722-6729).
†A detailed EOB includes carrier name and logo, name of the plan, patient's responsibility, Date of Service and drug code broken out by name, J-code or National Drug Code (NDC). EOBs should be submitted within 365 days from the Date of Service.
ACTEMRA is indicated for the treatment of adult patients with moderately to severely active rheumatoid arthritis (RA) who have had an inadequate response to one or more Disease-Modifying Anti-Rheumatic Drugs (DMARDs).
ACTEMRA is indicated for the treatment of giant cell arteritis (GCA) in adult patients.
ACTEMRA is indicated for the treatment of active polyarticular juvenile idiopathic arthritis (PJIA) in patients 2 years of age and older.
ACTEMRA is indicated for the treatment of active systemic juvenile idiopathic arthritis (SJIA) in patients 2 years of age and older.
ACTEMRA is indicated for slowing the rate of decline in pulmonary function in adult patients with systemic sclerosis-associated interstitial lung disease (SSc-ILD).
RISK OF SERIOUS INFECTIONS:
Patients treated with ACTEMRA are at increased risk for developing serious infections that may lead to hospitalization or death, including tuberculosis (TB), bacterial, invasive fungal, viral, or other opportunistic infections. If a serious infection develops, interrupt ACTEMRA until the infection is controlled.
Reported infections include:
The risks and benefits of treatment with ACTEMRA should be carefully considered prior to initiating therapy in patients with chronic or recurrent infection.
Patients should be closely monitored for the development of signs and symptoms of infection during and after treatment with ACTEMRA, including the possible development of tuberculosis in patients who tested negative for latent tuberculosis infection prior to initiating therapy.
ACTEMRA is contraindicated in patients with known hypersensitivity to ACTEMRA.
Other serious or potentially life-threatening adverse reactions that have been reported in clinical trials with ACTEMRA include gastrointestinal perforations. Use ACTEMRA with caution in patients who may be at risk for GI perforations.
Monitor patients for signs and symptoms of hepatic injury. Modify or discontinue ACTEMRA if abnormal liver tests persist or worsen or if clinical signs and symptoms of liver disease develop.
Laboratory monitoring is recommended due to potential consequences of treatment-related laboratory abnormalities in neutrophils, platelets, lipids, and liver function tests.
Hypersensitivity reactions, including anaphylaxis and death, have occurred.
Avoid use of live vaccines concurrently with ACTEMRA, as clinical safety has not been established.
Other potential risks of ACTEMRA include demyelinating disorders and malignancies.
Treatment with ACTEMRA is not recommended in patients with active hepatic disease or hepatic impairment.
Most common adverse reactions (≥ 5%) include upper respiratory tract infections, nasopharyngitis, headache, hypertension, increased ALT, injection site reactions (SC only).
You may report side effects to the FDA at (800) FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at 1-888-835-2555.
Please see additional Important Safety Information in accompanying full Prescribing Information, including BOXED WARNING.
Infusion-Related Reactions: Rituxan administration can result in serious, including fatal infusion-related reactions. Deaths within 24 hours of Rituxan infusion have occurred. Approximately 80% of fatal infusion reactions occurred in association with the first infusion. Monitor patients closely. Discontinue Rituxan infusion for severe reactions and provide medical treatment for Grade 3 or 4 infusion-related reactions.
Severe Mucocutaneous Reactions: Severe, including fatal, mucocutaneous reactions can occur in patients receiving Rituxan.
Hepatitis B Virus (HBV) Reactivation: HBV reactivation can occur in patients treated with Rituxan, in some cases resulting in fulminant hepatitis, hepatic failure, and death. Screen all patients for HBV infection before treatment initiation, and monitor patients during and after treatment with Rituxan. Discontinue Rituxan and concomitant medications in the event of HBV reactivation.
Progressive Multifocal Leukoencephalopathy (PML), including fatal PML, can occur in patients receiving Rituxan.
Rituxan administration can also result in additional serious, including fatal, adverse reactions including:
Rheumatoid Arthritis (RA)
Most common adverse reactions (≥10%) were upper respiratory tract infection, nasopharyngitis, urinary tract infection, and bronchitis. Other important adverse reactions include infusion-related reactions, serious infections, and cardiovascular events.
Granulomatosis With Polyangiitis (GPA) (Wegener's Granulomatosis) and Microscopic Polyangiitis (MPA)
Most common adverse reactions (≥15%) were infections, nausea, diarrhea, headache, muscle spasms, anemia, peripheral edema, and infusion-related reactions.
Pemphigus Vulgaris (PV)
Most common adverse reactions (≥15%) were infusion-related reactions, depression, upper respiratory tract infection/nasopharyngitis, and headache. Other important adverse reactions include infections.
You may report side effects to the FDA at (800) FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at 1-888-835-2555.
For additional Important Safety Information, please see the Rituxan full Prescribing Information, including BOXED WARNINGS.
We are open from 6 a.m.–5 p.m. PT, Monday through Friday, except for the following holidays:
Questions about this program?
Call (855) RA-COPAY (855-722-6729)
6 a.m.–5 p.m. PT, Monday through Friday (except major holidays)
Fax (800) 334-3030
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