ELIGIBLE PATIENTS MAY PAY NO MORE THAN $5 PER CO-PAY FOR EPCLUSA

We believe that cost should not be a barrier to receiving treatment. That’s why the makers of EPCLUSA offer a co-pay coupon. If you are eligible, you may pay no more than $5 per co-pay. Need a replacement coupon?

Please note the following:

  • You are not eligible if you are enrolled in a government healthcare prescription drug program such as Medicare Part D or Medicaid. This includes when you are in the Medicare Part D coverage gap known as the “donut hole.”

  • The EPCLUSA Co-pay Coupon Program will cover the out-of-pocket costs of your EPCLUSA prescriptions up to a maximum of 25% of the catalog price of a 12-week regimen of EPCLUSA. See Terms and Conditions below.

CHECK YOUR ELIGIBILITY BELOW

EPCLUSA is a prescription medicine used to treat adults with chronic (lasting a long time) hepatitis C (Hep C) genotype 1, 2, 3, 4, 5, or 6 infection with or without cirrhosis (compensated). In those with advanced cirrhosis (decompensated), EPCLUSA is used with ribavirin.

Important Safety Information

What should I tell my healthcare provider before taking EPCLUSA?

  • If you have: liver problems other than hepatitis C infection; severe kidney problems or are on dialysis; any other medical condition; or if you are pregnant or breastfeeding, or plan to become pregnant or breastfeed. It is not known if EPCLUSA will harm your unborn baby. If you take EPCLUSA with ribavirin, you should also read the ribavirin Medication Guide for important pregnancy-related information.

Continued below

CHECK YOUR ELIGIBILITY


Co-pay Coupon Terms and Conditions

  • The EPCLUSA Co-pay Coupon Program will cover the out-of-pocket costs of your EPCLUSA prescriptions after you pay the first $5 per prescription fill, up to a maximum of 25% of the catalog price of a 12-week regimen of EPCLUSA. The offer is valid for 6 months from the time of first redemption.
  • The EPCLUSA co-pay coupon (“Coupon”) can be used only by eligible residents of the U.S., Puerto Rico, or U.S. territories at participating eligible retail, specialty, or mail-order pharmacies in the U.S., Puerto Rico, or U.S. territories. Product must originate in the U.S., Puerto Rico, or U.S. territories. You must be at least 18 years old to use the Coupon for yourself or a minor.
  • The Coupon is limited to one per person and is not transferable. No substitutions are permitted. The Coupon is only available with a valid prescription. The offer cannot be combined with any other coupon, free trial, discount, prescription savings card, or other offer. Patient may not be currently receiving free drug assistance through Gilead Sciences, Inc. (“Gilead”)'s patient assistance programs.
  • The Coupon is not insurance and is not intended to substitute for insurance.
  • The Coupon is valid only for patients with commercial insurance or cash-pay patients and is not valid for prescriptions that are eligible to be reimbursed:
    • in whole or part by Medicare, Medicaid or a Medicare Part D plan, TRICARE, VA, DOD, Puerto Rico Government Health Insurance Plan (“Healthcare Reform”), or any other state- or federally funded healthcare benefit program (collectively, “Government Programs”); or
    • by commercial plans or other health or pharmacy benefit programs that reimburse for the entire cost of prescription drugs.
  • Patients without insurance coverage or who have commercial insurance that does not cover EPCLUSA are considered “cash-pay” patients. Medicare Part D enrollees who are in the prescription drug coverage gap (the “donut hole”) are not considered cash-pay patients, and are not eligible for the Coupon. Patients who begin receiving prescription benefits from such Government Programs at any time will no longer be eligible to use the Coupon. Void where prohibited by law, taxed, or restricted.
  • Patient, pharmacist, and prescriber agree not to seek reimbursement for all or any part of the benefit received by the patient through the offer. Both patient and pharmacist are each individually responsible for reporting receipt of Coupon benefit to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the Coupon, as required.
  • It is illegal to sell, purchase, trade, or counterfeit, or offer to sell, purchase, trade, or counterfeit the Coupon.
  • Certain information pertaining to your use of the Coupon will be shared with Gilead, the sponsor of the Coupon, and its affiliates. The information disclosed will include the date the prescription is filled, the number of pills or product dispensed by the pharmacists, and the amount of your co-pay that will be paid for by using the Coupon. For more information, please see the Gilead Privacy Policy at www.gilead.com.
  • Gilead reserves the right to terminate, rescind, revoke, or modify the Coupon at any time without notice.

Important Safety Information

What should I tell my healthcare provider before taking EPCLUSA? (continued)

  • Tell your healthcare provider and pharmacist about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. EPCLUSA and certain other medicines may affect each other, or may cause side effects. Tell your healthcare provider if you take any medicines containing tenofovir disoproxil fumarate (ATRIPLA®, COMPLERA®, STRIBILD®, TRUVADA®, VIREAD®).

What are the possible side effects of EPCLUSA?

  • EPCLUSA, when taken in combination with amiodarone (Cordarone®, Nexterone®, Pacerone®), a medicine used to treat certain heart problems, may cause serious side effects, including slow heart rate. In some cases slow heart rate has led to death or the need for a pacemaker when amiodarone is taken with medicines containing sofosbuvir and another antiviral medicine. Get medical help right away if you take amiodarone with EPCLUSA and get any of the following symptoms: fainting or near-fainting, dizziness or lightheadedness, not feeling well, weakness, extreme tiredness, shortness of breath, chest pains, confusion, or memory problems.
  • The most common side effects of EPCLUSA include headache and tiredness. When EPCLUSA is used with ribavirin for those with advanced cirrhosis, they also include anemia, nausea, insomnia, and diarrhea.

EPCLUSA is a prescription medicine used to treat adults with chronic (lasting a long time) hepatitis C (Hep C) genotype 1, 2, 3, 4, 5, or 6 infection with or without cirrhosis (compensated). In those with advanced cirrhosis (decompensated), EPCLUSA is used with ribavirin.

Important Safety Information

What should I tell my healthcare provider before taking EPCLUSA?

  • If you have: liver problems other than hepatitis C infection; severe kidney problems or are on dialysis; any other medical condition; or if you are pregnant or breastfeeding, or plan to become pregnant or breastfeed. It is not known if EPCLUSA will harm your unborn baby. If you take EPCLUSA with ribavirin, you should also read the ribavirin Medication Guide for important pregnancy-related information.
  • Tell your healthcare provider and pharmacist about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. EPCLUSA and certain other medicines may affect each other, or may cause side effects. Tell your healthcare provider if you take any medicines containing tenofovir disoproxil fumarate (ATRIPLA®, COMPLERA®, STRIBILD®, TRUVADA®, VIREAD®).

What are the possible side effects of EPCLUSA?

  • EPCLUSA, when taken in combination with amiodarone (Cordarone®, Nexterone®, Pacerone®), a medicine used to treat certain heart problems, may cause serious side effects, including slow heart rate. In some cases slow heart rate has led to death or the need for a pacemaker when amiodarone is taken with medicines containing sofosbuvir and another antiviral medicine. Get medical help right away if you take amiodarone with EPCLUSA and get any of the following symptoms: fainting or near-fainting, dizziness or lightheadedness, not feeling well, weakness, extreme tiredness, shortness of breath, chest pains, confusion, or memory problems.
  • The most common side effects of EPCLUSA include headache and tiredness. When EPCLUSA is used with ribavirin for those with advanced cirrhosis, they also include anemia, nausea, insomnia, and diarrhea.
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Important Safety Information

What should I tell my healthcare provider before taking EPCLUSA?

  • If you have: liver problems other than hepatitis C infection; severe kidney problems or are on dialysis; any other medical condition; or if you are pregnant or breastfeeding, or plan to become pregnant or breastfeed. It is not known if EPCLUSA will harm your unborn baby. If you take EPCLUSA with ribavirin, you should also read the ribavirin Medication Guide for important pregnancy-related information.