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Coordinate your insurance benefits with help from CIMplicity®2

CIMZIA is considered a specialty drug, and insurance companies often have special requirements that must be met before they agree to cover your medication. For instance, they may require you to try other medications before trying CIMZIA. That’s where CIMplicity®2 can help. We can verify whether CIMZIA is covered under your insurance plan. This is called a benefits investigation. We can also help your doctor’s office with paperwork the insurance company may require before starting CIMZIA, sometimes referred to as prior authorization.

Private (commercial) insurance

This type of insurance is often offered by an employer, or you can buy insurance through a private (non-government) insurance provider. Visit HealthCare.gov for more information about coverage available in your state. Programs and costs vary, especially in terms of coverage, co-pays, and deductibles.

About the Health Insurance Marketplace (the Exchange)

The Health Insurance Marketplace, also known as the Exchange, was created through the Affordable Care Act (ACA), also known as Obamacare. The Exchange is your state’s price comparison website for government-supported (subsidized) health insurance.

Each year, there is an open enrollment period. This is the only time you can enroll in a plan, switch plans, or apply for cost assistance. However, certain life events may qualify you for a special enrollment period.

For general insurance help, call 1-866-4-CIMZIA (1-866-424-6942, option 2).

Short-term and supplemental insurance

This type of insurance is temporary or serves as an addition to major medical coverage.

Short-term insurance

This is temporary health insurance when you are in between coverage. It is not considered minimum essential coverage.

Supplemental insurance

Supplemental insurance works as an addition to your major medical health insurance plan, and it is sold by private companies only. It is not provided by the government regardless of your income level. These plans can help pay some of the healthcare costs that your health insurance plan does not cover, like co-pays, coinsurance, and deductibles.

Medicare

Medicare is a federally funded health insurance program for:

  • People age 65 or older
  • People under 65 with certain disabilities
  • People of all ages with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant)

If you qualify for Medicare but need additional support to cover out-of-pocket expenses, there are supplemental insurance options that may help. For Medicare enrollees, there are certain rules that you must follow in order to get supplemental insurance. Please see the table below for a summary or visit www.medicare.gov for more detailed information on any of the Medicare policies listed.

Please note: Co-pay cards for prescription assistance cannot be used with Medicare.

Original Medicare Coverage Costs
1. Medicare Part A Inpatient hospital coverage; includes extended care facility (pays up to 80% of the cost) Most people do not pay a monthly premium. In 2015, each person has a $1260 deductible for each benefit period. Once the deductible is fulfilled, most people are responsible for paying 20% of the Medicare-approved cost
2. Medicare Part B

Optional outpatient insurance to cover services and supplies that are considered medically necessary (pays up to 80% of the cost)

Most injectable medications given at your doctor’s office or a hospital outpatient setting

In 2015, most people paid $104.90 each month, which is automatically deducted from their Social Security check. There is also a deductible of $147 for each benefit period

Enrollees are responsible for paying 20% of the Medicare-approved cost after they have fulfilled their deductible

Supplemental insurance*   Coverage Costs
3. Medicare Prescription Drug Plan
(Medicare Part D)

Optional prescription drug plan for outpatient pharmacies (adds drug coverage to original Medicare)

Cannot be used with Medigap

Monthly premium, co-pays, and drugs covered can vary by plan (higher-income enrollees may pay more)

To join Medicare Part D, you will need to give your Medicare number and the date your Part A and/or Part B coverage started

4. Medigap

Medigap can help pay for costs that original Medicare doesn’t cover, like co-pays, coinsurance, and deductibles

Medigap no longer offers prescription drug coverage, but you may be able to join the Medicare Prescription Play (Medicare Part D)

There are 10 different Medigap policies. Each insurance company decides which Medigap policies it wants to sell, although state laws might affect which one they offer

Each private insurance company decides how it will set the price, or premium, for its Medigap policies

It is important to ask how an insurance company prices its policies. The way they set the price affects how much you pay now and in the future

The cost of Medigap policies can vary greatly. There can be big differences in the premiums that different insurance companies charge for exactly the same coverage. Make sure that when you are comparing insurance companies, you are also comparing the same Medigap plan

5. Medicare Part C
(Medicare Advantage)

A type of Medicare plan that is provided by a private company. These policies must provide the minimum benefits of Medicare Part A and Part B and generally provide drug coverage

Medigap policies cannot be used to pay your Medicare Advantage Plan co-pays, deductibles, and premiums

Most people pay the Part B premium ($104.90) each month in addition to their Medicare Advantage premium; you may also pay a co-pay or coinsurance for covered services. Costs, extra coverage, and rules vary by plan
Original Medicare

1. Medicare Part A

Coverage: Inpatient hospital coverage; includes extended care facility (pays up to 80% of the cost)
Costs: Most people do not pay a monthly premium. In 2015, each person has a $1260 deductible for each benefit period. Once the deductible is fulfilled, most people are responsible for paying 20% of the Medicare-approved cost

2. Medicare Part B

Coverage: Optional outpatient insurance to cover services and supplies that are considered medically necessary (pays up to 80% of the cost)

Most injectable medications given at your doctor’s office or a hospital outpatient setting

Costs: In 2015, most people paid $104.90 each month, which is automatically deducted from their Social Security check. There is also a deductible of $147 for each benefit period

Enrollees are responsible for paying 20% of the Medicare-approved cost after they have fulfilled their deductible

Supplemental insurance*

3. Medicare Prescription Drug Plan (Medicare Part D)

Coverage: Optional prescription drug plan for outpatient pharmacies (adds drug coverage to original Medicare)

Cannot be used with Medigap

Costs: Monthly premium, co-pays, and drugs covered can vary by plan (higher-income enrollees may pay more)

To join Medicare Part D, you will need to give your Medicare number and the date your Part A and/or Part B coverage started

4. Medigap

Coverage: Medigap can help pay for costs that original Medicare doesn’t cover, like co-pays, coinsurance, and deductibles

Medigap no longer offers prescription drug coverage, but you may be able to join the Medicare Prescription Play (Medicare Part D)

There are 10 different Medigap policies. Each insurance company decides which Medigap policies it wants to sell, although state laws might affect which one they offer

Costs: Each private insurance company decides how it will set the price, or premium, for its Medigap policies

It is important to ask how an insurance company prices its policies. The way they set the price affects how much you pay now and in the future

The cost of Medigap policies can vary greatly. There can be big differences in the premiums that different insurance companies charge for exactly the same coverage. Make sure that when you are comparing insurance companies, you are also comparing the same Medigap plan

5.Medicare Part C (Medicare Advantage)

Coverage: A type of Medicare plan that is provided by a private company. These policies must provide the minimum benefits of Medicare Part A and Part B and generally provide drug coverage

Medigap policies cannot be used to pay your Medicare Advantage Plan co-pays, deductibles, and premiums

Costs: Most people pay the Part B premium ($104.90) each month in addition to their Medicare Advantage premium; you may also pay a co-pay or coinsurance for covered services. Costs, extra coverage, and rules vary by plan

*Supplemental plans are purchased through private companies and are not available through government-sponsored websites.

Medigap policies can be priced (or rated) in 3 different ways: community-rated (pay the same premium, regardless of age), issue-age-rated (the younger you are when you buy, the cheaper it will be; price will not change as you age), and attained-age-rate (premium is based on your current age, so your premium goes up as you get older).

Medicaid

Medicaid is a type of insurance that is provided by the state where you live. It is specifically designed to provide health coverage for:

  • Low-income adults
  • Children and pregnant women
  • People who qualify under an eligible category
  • People age 65 and older
  • Individuals with disabilities 

Visit Medicaid.gov for more information, to sign up, and to see what kind of coverage you may be able to receive. Medicaid is provided by states based on federal requirements. It is jointly funded by states and the federal government and is available to individuals who earn less than $16,243.*

*Annual salaries are based on the 2015 Federal Poverty Limit (FPL) guidelines. For more information and to see the full FPL table, please visit http://obamacarefacts.com/federal-poverty-level/.

For general insurance help, call 1-866-4-CIMZIA (1-866-424-6942, option 2).

No insurance

If you are uninsured, other financial assistance may be available through the Patient Assistance Program (PAP). Call 1-866-395-8366 (option 4) and we may be able to put you in touch with an independent organization that can help.

Key terms to know

For a downloadable PDF of the glossary, click here.

Benefit period: The amount of time you are covered under the terms of your insurance plan.

Benefits investigation: Checking to see if a service or prescription is covered under your insurance plan.

Coinsurance: Your share of the cost of a covered healthcare service, usually a percentage of the allowed amount for the service (for example, 10%). You pay coinsurance after you’ve met your deductible.

Co-pay: A flat fee you pay for certain covered services such as a doctor’s visit or prescriptions. The amount can vary depending on the type of insurance you have or the service being performed.

Co-pay savings program: Usually sponsored by a drug company, these programs offer assistance paying the co-pay portion of a particular treatment or service.

Deductible: A flat dollar amount you must pay out of your own pocket before your plan begins to pay for covered services.

Exchange plan: The insurance you set up through the Healthcare Insurance Marketplace.

Income verification: Proof of how much money you earn from your job or receive through government assistance.

Inpatient: Healthcare treatment you receive when you’re admitted to a healthcare facility like a hospital or nursing facility.

Medically necessary: Healthcare services or supplies that are needed in order to diagnose or treat an illness, injury, disease, condition, or symptoms and that meet accepted standards of medicine.

Medicare Advantage: Also known as Medicare Part C. This Medicare plan is offered by a private company that contracts with Medicare to provide you with Medicare Part A and Part B benefits.

Medicare-approved cost: The amount Medicare will pay for a specific healthcare service or treatment.

Medicare Part D: A program that helps pay for prescription drugs for people with Medicare.

Medigap: Extra health insurance you can buy from a private company to pay healthcare costs not covered by original Medicare (for example, co-pays, deductibles, and healthcare if you travel outside the United States).

Minimum essential coverage: The amount of insurance coverage a person needs to meet the individual responsibility requirement under the Affordable Care Act.

Open enrollment period: The time period when a person can sign up for a health insurance plan.

Out of network: When you receive healthcare services from providers who are not covered by your health insurance.

Outpatient: When you receive healthcare services without being admitted to a hospital or healthcare facility.

Premium: The amount of money that you must pay for health insurance. You (or your employer) may pay your premium every month, every quarter, or once a year.

Prior authorization: Getting your health plan’s approval for a service or prescription ahead of time to be sure that service or prescription will be covered.

Additional Service icon

To create your CIMplicity®2 profile and receive help coordinating your insurance benefits, sign up here.

1Co-Pay Savings Card Eligibility: Available to patients with commercial prescription insurance coverage for CIMZIA. Not valid for prescriptions that are reimbursed, in whole or in part, under Medicare (including Medicare Part D), Medicaid, similar federal- or state-funded programs (including any state prescription drug assistance programs and the Government Health Insurance Plan available in Puerto Rico), or where otherwise prohibited by law. Product dispensed pursuant to program rules and federal and state laws. Claims should not be submitted to any public payor (ie, Medicare, Medicaid, Medigap, Tricare, VA, and DoD) for reimbursement. Patients and pharmacists are responsible for notifying insurance carriers or any other third party who pays for or reimburses any part of the prescription filled using this card as may be required by the insurance carrier’s terms and conditions and applicable law. The maximum annual benefit amount is $15,000 per calendar year. The parties reserve the right to amend or end this program at any time without notice.

2The CIMplicity program is provided as a service of UCB and is intended to support the appropriate use of CIMZIA. The CIMplicity program may be amended or cancelled at any time without notice. Some program and eligibility restrictions may apply.

Your safety is important to us. Learn about our Important Safety Information.

Important Safety Information You Should Know About CIMZIA® (certolizumab pegol)

What is the most important information I should know about CIMZIA?

CIMZIA is a medicine that affects your immune system. CIMZIA can lower the ability of the immune system to fight infections. Serious infections have happened in patients taking CIMZIA, including tuberculosis (TB) and infections caused by viruses, fungi, or bacteria that have spread throughout the body. Some patients have died from these infections.

  • Your healthcare provider should test you for TB before starting CIMZIA.
  • Your healthcare provider should monitor you closely for signs and symptoms of TB during treatment with CIMZIA.

You should not start receiving CIMZIA if you have any kind of infection unless your healthcare provider says it is okay.

Before you receive CIMZIA, tell your healthcare provider if you:

  • think you have an infection, flu-like symptoms, or have any other symptoms of an infection such as: 
    • fever, sweat, or chills
    • muscle aches
    • cough
    • shortness of breath
    • blood in phlegm
    • weight loss
    • warm, red, or painful skin or sores on your body
    • diarrhea or stomach pain
    • burning when you urinate or urinate more often than normal
    • feeling very tired 
  • are being treated for an infection, or get a lot of infections or have infections that keep coming back
  • have diabetes, HIV, or a weak immune system. People with these conditions have a higher chance for infections.
  • have tuberculosis (TB), or have been in close contact with someone with TB
  • were born in, lived in, or traveled to countries where there is more risk of getting TB. Ask your healthcare provider if you are not sure.
  • live or have lived in certain parts of the country (such as the Ohio and Mississippi River valleys) where there is an increased risk for getting certain kinds of fungal infections (histoplasmosis, coccidioidomycosis, blastomycosis). These infections may develop or become more severe if you take CIMZIA. If you do not know if you have lived in an area where histoplasmosis, coccidioidomycosis, or blastomycosis is common, ask your healthcare provider.
  • have or have had hepatitis B
  • use the medicine Kineret® (anakinra), Orencia® (abatacept), Rituxan® (rituximab), or Tysabri® (natalizumab)

After starting CIMZIA, if you get an infection, any sign of an infection including a fever, cough, flu-like symptoms, or have open cuts or sores on your body, call your healthcare provider right away. CIMZIA can make you more likely to get infections or make any infection that you may have worse.

Cancer

  • For people taking TNF-blocker medicines, including CIMZIA, the chances of getting lymphoma or other cancers may increase.
  • There have been cases of cancers in children, teenagers, and young adults who received TNF-blocker medicine that do not usually happen in people this age. CIMZIA is not approved for use in pediatric patients. People with RA, especially more serious RA, may have a higher chance for getting a kind of cancer called lymphoma.
  • Some people receiving TNF-blocker medicines, including CIMZIA, have developed a rare type of cancer called hepatosplenic T-cell lymphoma. This type of cancer often results in death. Most of these people were male teenagers and young males with Crohn’s disease or ulcerative colitis. Also, most of these people had been treated with both a TNF-blocker medicine and another medicine called IMURAN® (azathioprine) or PURINETHOL® (6-mercaptopurine, 6-MP).
  • If you use TNF-blocker medicine, including CIMZIA, your chance of developing certain kinds of skin cancer may increase. Tell your healthcare provider if any changes in the appearance of your skin, including growths on your skin, happen during or after your treatment.

What is CIMZIA?

CIMZIA is a prescription medicine called a Tumor Necrosis Factor (TNF) blocker. CIMZIA is used in adult patients to:

  • Lessen the signs and symptoms of moderately to severely active Crohn’s disease (CD) in patients who have not been helped enough by usual treatments.
  • Treat moderately to severely active rheumatoid arthritis (RA).
  • Treat active psoriatic arthritis (PsA).
  • Treat active ankylosing spondylitis (AS).

What should I tell my healthcare provider before starting treatment with CIMZIA?

CIMZIA may not be right for you. Before starting CIMZIA, tell your healthcare provider about all of your medical conditions, including if you:

  • have an infection
  • have or have had any type of cancer
  • have congestive heart failure
  • have seizures, any numbness or tingling, or a disease that affects your nervous system such as multiple sclerosis
  • are scheduled to receive a vaccine. Do not receive a live vaccine while taking CIMZIA.
  • are allergic to any of the ingredients in CIMZIA.
  • are pregnant or planning to become pregnant. It is not known if CIMZIA will harm your unborn baby. Tell your healthcare provider right away if you become pregnant while receiving CIMZIA.
    Pregnancy Registry: If you become pregnant while taking CIMZIA, talk to your healthcare provider about registering in the pregnancy exposure registry for CIMZIA. You can enroll in this registry by calling 1-877-311-8972. The purpose of this registry is to collect information about the safety of CIMZIA during pregnancy.
  • are breastfeeding or plan to breastfeed. It is not known if CIMZIA passes into your breast milk. You and your healthcare provider should decide if you will receive CIMZIA or breastfeed.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Especially tell your healthcare provider if you take the following medicines due to a higher chance for serious infections:

  • Kineret® (anakinra), Orencia® (abatacept), Rituxan® (rituximab), or Tysabri® (natalizumab)
  • medicines called Tumor Necrosis Factor (TNF) blockers, such as Remicade® (infliximab), Humira® (adalimumab), Enbrel® (etanercept), or Simponi® (golimumab)

Ask your healthcare provider if you are not sure. You should not take CIMZIA while you take any of these medicines.

How should I receive CIMZIA?

CIMZIA comes as a lyophilized powder or a solution in a prefilled syringe for injection. If your healthcare provider prescribes the CIMZIA powder, CIMZIA should be injected by a healthcare provider. If your healthcare provider prescribes the prefilled syringe, you will be trained on how to inject CIMZIA. See the booklet called “Instructions for Use” packaged in your CIMZIA prefilled syringe kit for complete instructions for use. Do not give yourself an injection of CIMZIA unless you have been shown by your healthcare provider, or they can train someone you know to help you with your injection. CIMZIA is given by an injection under the skin. Your healthcare provider will tell you how much and how often to inject CIMZIA. Do not use more CIMZIA or inject more often than prescribed.

What are the possible side effects of CIMZIA? CIMZIA can cause serious side effects including:

  • Heart Failure including new heart failure or worsening of heart failure you already have. Symptoms include shortness of breath, swelling of your ankles or feet, or sudden weight gain.
  • Allergic Reactions. Signs of an allergic reaction include a skin rash, swelling or itching of the face, tongue, lips, or throat, or trouble breathing.
  • Hepatitis B virus reactivation in patients who carry the virus in their blood. In some cases, patients have died as a result of hepatitis B virus being reactivated. Your healthcare provider should monitor you carefully before and during treatment with CIMZIA to see if you carry the hepatitis B virus in your blood. Tell your healthcare provider if you have any of the following symptoms:
    • feel unwell
    • skin or eyes look yellow
    • tiredness (fatigue)
    • poor appetite or vomiting
    • pain on the right side of your stomach (abdomen)
  • New or worsening nervous system problems, such as multiple sclerosis (MS), Guillain-Barre syndrome, seizures, or inflammation of the nerves of the eyes. Symptoms may include:
    • dizziness
    • numbness or tingling
    • problems with your vision
    • weakness in your arms or legs
  • Blood Problems. Your body may not make enough of the blood cells that help fight infections or help stop bleeding. Symptoms include a fever that does not go away, bruising or bleeding very easily, or looking very pale.
  • Immune reactions including a lupus-like syndrome. Symptoms include shortness of breath, joint pain, or a rash on the cheeks or arms that worsens with sun exposure.

Call your healthcare provider right away if you have any side effects listed above.

The most common side effects of CIMZIA include: upper respiratory infections (flu, cold), rash, and urinary tract infections (bladder infections).

Tell your healthcare provider about any side effect that bothers you or does not go away. These are not all of the possible side effects of CIMZIA. For more information, ask your healthcare provider or pharmacist.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Please see the Medication Guide for CIMZIA and discuss it with your healthcare provider.