2020 Guide to Patient Support Services

Clovis Oncology

Clovis Oncology’s Rubraca Connections is a comprehensive patient support services program, including the Rubraca $0 Co-Pay Program, the Rubraca Connections Quick Start Program, and the Rubraca Connections Patient Assistance Program.

This program is designed to help patients who are prescribed Rubraca (rucaparib) tablets. This includes coordinating Rubraca delivery and pick-up, finding financial support programs, and connecting patients with a specialty pharmacy team.

Rubraca is a poly (ADP-ribose) polymerase (PARP) inhibitor indicated for the maintenance treatment of adults with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer in a complete or partial response to platinum-based chemotherapy; treatment of adults with deleterious BRCA mutation (germline and/or somatic)-associated epithelial ovarian, fallopian tube, or primary peritoneal cancer after ≥2 chemotherapies (Table).

RUBRACA CONNECTIONS SERVICES

Rubraca Connections provides several support services for patients who have been prescribed Rubraca.

Rubraca $0 Co-Pay Program

The Rubraca $0 Co-Pay Program provides the out-of-pocket costs for eligible patients. Patients with private or commercial insurance may qualify for the Rubraca $0 Co-Pay Program, which provides 100% of the patient’s out-of-pocket drug costs for Rubraca for up to $30,000 annually, regardless of the patient’s income.

Rubraca Connections QuickStart Program

The Rubraca Connections QuickStart Program may provide the first 15 days of Rubraca at no cost, up to 3 refills (or 60 days). This program is for eligible patients who have private (commercial) or government insurance and are experiencing delays in coverage for Rubraca.

Rubraca Connections Patient Assistance Program

The Rubraca Connections Patient Assistance Program provides free medication to eligible uninsured or underinsured patients. Patients without health insurance or with insurance that does not cover the cost of Rubraca may be eligible for the Rubraca Connections Patient Assistance Program.

ELIGIBILITY

Rubraca $0 Co-Pay Program

To be eligible for the Rubraca $0 Co-Pay Program, patients must:

  • Be a resident of the United States, Puerto Rico, or US territories
  • Have private or commercial ­insurance
  • Not be covered by federal- or state-funded insurance
  • Not be cash-paying patients without commercial insurance.

Rubraca Connections Patient Assistance Program

To be eligible for the Rubraca Connections Patient Assistance Program, patients must:

  • Have a household income that meets income requirements
  • Be a resident of the United States
  • Be uninsured or rendered uninsured
  • Have a prescription for an FDA-approved indication for Rubraca.

Rubraca Connections QuickStart Program

To be eligible for the Rubraca Connections QuickStart Program, patients must:

  • Have a prescription for Rubraca for an FDA-approved indication
  • Have private (commercial) or government insurance and be experiencing a delay in medication coverage
  • Not bill the cost of Rubraca provided through this program to an insurance provider
  • Obtain a separate QuickStart prescription for the pharmacy supporting the program.

APPLICATION & ENROLLMENT

Rubraca $0 Co-Pay Program

Eligible patients can enroll in the Rubraca $0 Co-Pay Program by completing the online enrollment form or by calling Rubraca Connections at 844-779-7707.

Rubraca Connections Patient Assistance Program

To enroll a patient in this program, patients and their prescribers can complete the Rubraca Connections prescription form and fax it to 844-779-7717, or mail it to the address listed on the form. Alternatively, patients can enroll by calling Rubraca Connections at 844-779-7707.

Rubraca Connections QuickStart Program

To enroll in the Rubraca Connections QuickStart Program, the patient should complete the Rubraca Prescription Form, along with the prescribing physician, and fax the completed form to 844-779-7717, or to a network specialty pharmacy. Enrollees can also submit their prescription online via Rubraca eRx and eSupport Solutions.

TABLE CLOVIS ONCOLOGY DRUG

Drug
Indications
Patient support programs

Drug
Rubraca (rucaparib) tablets
Indications
Maintenance treatment of adults with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer in a complete or partial response to platinum-based chemotherapy; treatment of adults with deleterious BRCA mutation (germline and/or somatic)-associated epithelial ovarian, fallopian tube, or primary peritoneal cancer after ≥2 chemotherapies
Patient support programs

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