Adalimumab-fkjp Copay Assistance Program Terms and Conditions

With this adalimumab-fkjp Copay Assistance Program, eligible patients may pay as little as $0 for each monthly fill of adalimumab-fkjp injection, while this program remains in effect. Subject to all other terms and conditions, this copay assistance program may be used to reduce the amount of an eligible patient’s out-of-pocket costs for adalimumab-fkjp injection up to the full amount of the patient’s out-of-pocket cost per prescription, which may be up to a 90-day supply, subject to a maximum savings per prescription while this copay assistance program remains in effect. Whether a patient is eligible to receive the maximum savings amount is determined by the type of commercial insurance plan coverage the patient has and may vary among individual patients covered by different plans. Additional information on the program and whether your particular insurance coverage is likely to result in your reaching the maximum aggregate amount can be obtained by calling 1-833-61-BIOCON. No other purchase is necessary. Valid prescription is required. Biocon Biologics reserves the right to amend or end this copay assistance program at any time without notice.

Eligibility Requirements: This copay assistance can be redeemed only by patients or patient guardians who are 18 years of age or older and who are residents of the U.S. or Puerto Rico. Patients must have commercial prescription drug insurance with coverage for adalimumab-fkjp injection. This copay assistance program is not valid for uninsured patients or commercially insured patients without coverage for adalimumab-fkjp injection; not valid for patients who are covered in whole or in part by any state or federally funded healthcare program, including, but not limited to, any state pharmaceutical assistance program, (Medicare Part D or otherwise), Medicaid, Medigap, VA or DOD, or TRICARE (regardless of whether adalimumab-fkjp injection is covered by such government program); not valid if the patient is Medicare eligible and enrolled in an employer-sponsored health plan or prescription benefit program for retirees; and not valid if the patient’s insurance plan is paying the entire cost of this prescription. This copay assistance program is void outside the U.S. or Puerto Rico or in any state or jurisdiction where prohibited by law, taxed or restricted. Absent a change in Massachusetts law, this copay assistance program will no longer be valid for Massachusetts residents as of January 1, 2026.

This copay assistance program is not health insurance. The copay assistance program is not transferable, and the amount of the savings cannot exceed the patient’s out-of-pocket costs. Cannot be combined with any other rebate/coupon, cash discount card, free trial, or similar offer for the specified prescription. This copay assistance is not redeemable for cash. This copay assistance is not valid for product dispensed by a 340B covered entity that purchased the product at discounted pricing under the 340B drug pricing program.

The value of this copay assistance program is exclusively for the benefit of patients and is intended to be credited solely towards patient out-of-pocket costs, including applicable co-payments, coinsurance, and deductibles. This copay assistance is not available if the patient’s commercial insurance plan, pharmacy benefit manager, or other plan agent uses a copay adjustment program that restricts program payments from being applied to satisfy the patient’s out-of-pocket costs or counted toward the patient’s out-of-pocket maximum limits. This copay assistance program also is not available to patients who are members of insurance plans that adjust, reduce, or waive their patients. out-of-pocket costs based on the availability of, or a member’s participation in, manufacturer-sponsored copay assistance. These programs are often referred to as accumulator adjustment or maximizer programs. Patients with these plan terms may not use this copay assistance program but may be eligible for other needs-based assistance provided by Biocon Biologics. If you believe your commercial insurance plan may have such terms, please contact 1-833-61-BIOCON. Biocon Biologics, in its sole discretion, may reduce or eliminate program benefits for any patient whose plan requires enrollment in the program as a condition of participation in any plan or plan benefit, coverage, or program or otherwise imposes different or additional requirements on patients who receive this copay assistance.

NOTICE. Data related to your use of this copay assistance program may be collected, analyzed and shared with Biocon Biologics for market research and other purposes related to assessing its copay assistance programs. Data shared with Biocon Biologics will be aggregated and de-identified, meaning it will be combined with data related to other copay assistance program redemptions and will not identify you.

Use of this copay assistance program must be consistent with the terms of any drug benefit provided by a commercial health insurer, health plan or private third-party payer. Patients must have not submitted and will not submit a claim for reimbursement under any federal, state or other governmental programs for this prescription. Patients are responsible for reporting the receipt of copay assistance to any commercial insurer, health plan, or third-party payer who pays for or reimburses any part of the prescription filled, as may be required. Patients should not use this copay assistance program if their health plan prohibits use of manufacturer copay assistance programs. Patients should withdraw from this copay assistance program should they begin to receive prescription benefits from any government funded program by calling 1-833-61-BIOCON

By utilizing this copay assistance program, you hereby accept and agree to abide by these terms and conditions. Any individual or entity who enrolls or assists in the enrollment of a patient in the copay assistance program represents that the patient meets the eligibility criteria and other requirements described herein. Further, you agree that you currently meet the eligibility criteria and other requirements described herein every time you use this copay assistance program.

Important Safety Information

What is the most important information I should know about Adalimumab-fkjp?

You should discuss the potential benefits and risks of Adalimumab-fkjp with your doctor. Adalimumab-fkjp is a TNF blocker medicine that can lower the ability of your immune system to fight infections. You should not start taking Adalimumab-fkjp if you have any kind of infection unless your doctor says it is okay.

Serious infections

Serious infections have happened in people taking adalimumab products. These serious infections include tuberculosis (TB) and infections caused by viruses, fungi, or bacteria that have spread throughout the body. Some people have died from these infections. Your doctor should test you for TB before starting Adalimumab-fkjp and check you closely for signs and symptoms of TB during treatment with Adalimumab-fkjp, even if your TB test was negative. If your doctor feels you are at risk, you may be treated with medicine for TB.

Cancer

For children and adults taking TNF blockers, including Adalimumab-fkjp, the chance of getting lymphoma or other cancers may increase. There have been cases of unusual cancers in children, teenagers, and young adults using TNF blockers. Some people have developed a rare type of cancer called hepatosplenic T-cell lymphoma. This type of cancer often results in death. If using TNF blockers, including Adalimumab-fkjp, your chance of getting two types of skin cancer (basal cell and squamous cell) may increase. These types are generally not life-threatening if treated. Tell your doctor if you have a bump or open sore that doesn’t heal.

What should I tell my doctor BEFORE starting Adalimumab-fkjp?

Tell your doctor about all of your health conditions, including if you:

Have an infection, are being treated for infection, or have symptoms of an infection
Get a lot of infections or infections that keep coming back
Have diabetes
Have TB or have been in close contact with someone with TB, or were born in, lived in, or traveled where there is more risk for getting TB
Live or have lived in an area (such as the Ohio and Mississippi River valleys) where there is an increased risk for getting certain kinds of fungal infections, such as histoplasmosis, coccidioidomycosis, or blastomycosis. These infections may happen or become more severe if you use Adalimumab-fkjp. Ask your doctor if you are unsure if you have lived in an area where these infections are common.
Have or have had hepatitis B
Are scheduled for major surgery
Have or have had cancer
Have numbness or tingling or a nervous system disease such as multiple sclerosis or Guillain-Barré syndrome
Have or had heart failure
Have recently received or are scheduled to receive a vaccine. Adalimumab-fkjp patients may receive vaccines, except for live vaccines. Children should be brought up to date on all vaccines before starting Adalimumab-fkjp
Are allergic to Adalimumab-fkjp or to any of its ingredients
Are pregnant, planning to become pregnant, breastfeeding, or planning to breastfeed
Have a baby and you were using Adalimumab-fkjp during your pregnancy. Tell your baby’s doctor before your baby receives any vaccines

Also tell your doctor about all the medicines you take. You should not take Adalimumab-fkjp with ORENCIA^® (abatacept), KINERET^® (anakinra), REMICADE ^® (infliximab), ENBREL^® (etanercept), CIMZIA^® (certolizumab pegol), or SIMPONI^® (golimumab). Tell your doctor if you have ever used RITUXAN^® (rituximab), IMURAN^® (azathioprine), or PURINETHOL ^® (6-mercaptopurine, 6-MP).

What should I watch for AFTER starting Adalimumab-fkjp?

Adalimumab-fkjp can cause serious side effects, including:

Serious infections. These include TB and infections caused by viruses, fungi, or bacteria. Symptoms related to TB include a cough, low-grade fever, weight loss, or loss of body fat and muscle.
Hepatitis B infection in carriers of the virus. Symptoms include muscle aches, feeling very tired, dark urine, skin or eyes that look yellow, little or no appetite, vomiting, clay-colored bowel movements, fever, chills, stomach discomfort, and skin rash.
Allergic reactions. Symptoms of a serious allergic reaction include hives, trouble breathing, and swelling of your face, eyes, lips, or mouth.
Nervous system problems. Signs and symptoms include numbness or tingling, problems with your vision, weakness in your arms or legs, and dizziness.
Blood problems (decreased blood cells that help fight infections or stop bleeding). Symptoms include a fever that does not go away, bruising or bleeding very easily, or looking very pale.
Heart failure (new or worsening). Symptoms include shortness of breath, swelling of your ankles or feet, and sudden weight gain.
Immune reactions including a lupus-like syndrome. Symptoms include chest discomfort or pain that does not go away, shortness of breath, joint pain, or rash on your cheeks or arms that gets worse in the sun.
Liver problems. Symptoms include feeling very tired, skin or eyes that look yellow, poor appetite or vomiting, and pain on the right side of your stomach (abdomen). These problems can lead to liver failure and death.
Psoriasis (new or worsening). Symptoms include red scaly patches or raised bumps that are filled with pus.

Call your doctor or get medical care right away if you develop any of the above symptoms.

The most common side effects of Adalimumab-fkjp include injection site reactions (pain, redness, rash, swelling, itching, or bruising), upper respiratory infections (sinus infections), headaches, and rash. These are not all of the possible side effects with Adalimumab-fkjp. Tell your doctor if you have any side effect that bothers you or that does not go away.

Remember, tell your doctor right away if you have an infection or symptoms of an infection, including:

Fever, sweats, 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
Urinating more often than normal
Feeling very tired

If you have any questions about this information, be sure to discuss them with your healthcare provider.

APPROVED USES

Adalimumab-fkjp is a prescription medicine used:

To reduce the signs and symptoms of:
- Moderate to severe rheumatoid arthritis (RA) in adults. Adalimumab-fkjp can be used alone, with methotrexate, or with certain other medicines. Adalimumab-fkjp may prevent further damage to your bones and joints and may help your ability to perform daily activities.
- Moderate to severe polyarticular juvenile idiopathic arthritis (JIA) in children 2 years of age and older. Adalimumab-fkjp can be used alone or with methotrexate.
- Psoriatic arthritis (PsA) in adults. Adalimumab-fkjp can be used alone or with certain other medicines. Adalimumab-fkjp may prevent further damage to your bones and joints and may help your ability to perform daily activities.
- Ankylosing spondylitis (AS) in adults.
- Moderate to severe hidradenitis suppurativa (HS) in adults.
To treat moderate to severe Crohn’s disease (CD) in adults and children 6 years of age and older.
To treat moderate to severe ulcerative colitis (UC) in adults. It is not known if adalimumab products are effective in people who stopped responding to or could not tolerate TNF-blocker medicines.
To treat moderate to severe chronic plaque psoriasis (Ps) in adults who are ready for systemic therapy or phototherapy and are under the care of a doctor who will decide if other systemic therapies are less appropriate.
To treat non-infectious intermediate (middle part of the eye), posterior (back of the eye), and panuveitis (all parts of the eye) in adults.

IMPORTANT SAFETY INFORMATION