Clovis Oncology: Rubraca Connections

Patient Support Services Guide 2018


Rubraca Connections
844-779-7707

Clovis Oncology’s Rubraca Connections is a comprehensive patient support services program 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 as monotherapy for the treatment of patients with advanced ovarian cancer associated with germline and/or somatic deleterious BRCA mutation who have received ≥2 chemotherapies.

Rubraca Connections Services

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

Rubraca $0 Co-Pay Program covers out-of-pocket costs for eligible, commercially insured patients.

Rubraca Connections Patient Assistance Program provides free medication to eligible uninsured patients.

Rubraca Connections Coverage Link provides support to patients who are experiencing delays in accessing Rubraca because of insurance challenges. This program includes the following services:

  • Assisting in identifying independent copay foundations that can provide financial assistance for patients with government insurance, if needed
  • Facilitating delivery of Rubraca from the physician’s office or a specialty pharmacy to the patient
  • Helping patients determine their insurance type and coverage
  • 24/7 treatment support from the specialty pharmacy team.

Eligibility

Rubraca $0 Co-Pay Program

Patients with private or commercial insurance may qualify for the Rubraca $0 Co-Pay Program, which covers 100% of out-of-pocket drug costs for up to $24,000 annually. Eligibility requirements for this program include:

  • Residence in the United States, Puerto Rico, or US territories
  • Having private or commercial insurance
  • Not being covered by federally or state-funded insurance
  • Not being cash-paying patients without commercial insurance.

Rubraca Connections Patient Assistance Program

Patients without health insurance or with health insurance that does not cover Rubraca may be eligible for the Rubraca Connections Patient Assistance Program. Eligibility requirements include:

  • Household income based on financial/income evaluation
  • Residence in the United States
  • Uninsured or rendered uninsured status
  • A diagnosis consistent with Rubraca’s approved indication.

Rubraca Connections Coverage Link

Rubraca Connections Coverage Link is designed to support patients experiencing current insurance challenges. Eligible patients receive a 15-day supply of Rubraca for up to 90 days during insurance coverage investigations. Eligibility requirements include:

  • Having a diagnosis consistent with Rubraca’s package insert
  • Having commercial insurance, or, if uninsured, being in the process of applying for commercial insurance
  • Not having federally or state-funded insurance.

Patients with government insurance, including Medicare, Medicaid, or VA/DoD, may be able to get help with out-of-pocket drug costs from an independent copay foundation. An Access Specialist can help with a list of potential foundations.

Rubraca Connections can help determine the patient’s eligibility and coordinate the financial assistance process.

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 Coverage Link

To enroll in Rubraca Connections Coverage Link, prescribers can check the appropriate prescription box in the corresponding section of the Rubraca Connections prescription form and fax it to 844-779-7717 or to a network specialty pharmacy, or submit a prescription online.

Table Clovis Oncology Drug

Drug
Indication
Patient support programs

Drug
Rubraca (rucaparib) tablets
Indication
Advanced ovarian cancer associated with germline and/or somatic deleterious BRCA mutation, after ≥2 chemotherapies