CHECK YOUR
CO-PAY COUPON
ELIGIBILITY

EPCLUSA is a prescription medicine used to
treat adults with chronic hepatitis C (Hep C)
genotype 1-6 infection with or without cirrhosis
(compensated).

Important Safety Information

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

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

EPCLUSA can cause serious side effects, including:

EPCLUSA can cause serious side effects, including:

  • Hepatitis B virus reactivation: Before starting
    EPCLUSA treatment, your healthcare provider will
    do blood tests to check for hepatitis B infection. If
    you have ever had hepatitis B, the hepatitis B virus
    could become active again during and after
    treatment with EPCLUSA. This may cause serious
    liver problems including liver failure and death. If
    you are at risk, your healthcare provider will monitor
    you during and after taking EPCLUSA.

    Hepatitis B virus reactivation:
    Before starting EPCLUSA treatment,
    your healthcare provider will do blood
    tests to check for hepatitis B infection.
    If you have ever had hepatitis B, the
    hepatitis B virus could become active
    again during and after taking
    EPCLUSA. This may cause serious liver
    problems including liver failure and
    death. If you are at risk, your
    healthcare provider will monitor you
    during and after taking EPCLUSA.

See complete Important Safety
Information below

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Are you a current resident of the 50 states, District of Columbia, Puerto Rico, Guam, or the Virgin Islands?

Are your prescriptions paid for in part or in full by any state- or federally funded program, including but not limited to Medicare or Medicaid, Medigap, VA, DOD, or TRICARE? Please note that Medicare part D enrollees, while in the prescription drug coverage gap (the “donut hole”), are not eligible for the Co-pay Coupon.

If you begin receiving prescription benefits from such state- or federally funded programs at any time, you will no longer be eligible to use the Co-pay Coupon. Do you acknowledge your agreement with this statement?

For financial or insurance assistance,
call 1-855-769-7284.

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Co-pay Coupon Terms and Conditions

  • The EPCLUSA® Co-pay Coupon Program will cover the out-of-pocket costs of your eligible EPCLUSA prescription after you pay the first $5 per prescription fill, up to a maximum of 25% of the catalog price of 12 weeks (3 bottles) 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 pharmacies in the U.S., Puerto Rico, or U.S. territories. Product must be dispensed in the U.S., Puerto Rico, or U.S. territories. Coupon user must be at least 18 years old to use the Coupon for themselves or on behalf of 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 program for that product(s).

  • The Coupon is not insurance and is not intended to substitute for insurance. The Coupon is valid only for patients with commercial insurance and is not valid for prescriptions that are eligible to be reimbursed:

  • in whole or in part by Medicare or a Medicare Part D plan, Medicaid, TRICARE, VA, DOD, Puerto Rico Government Health Insurance Plan, 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 or prohibit the Coupon’s use.

  • Medicare Part D enrollees who are in the prescription drug coverage gap (the “donut hole”) are not eligible for the Coupon. Patients who begin receiving prescription benefits from 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 may be 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 patient co-pay ID, pharmacy demographics, prescriber information, and details relating to the coupon claim, such as co-pay amount, insurance details, and the therapy received. For more information, please see the Gilead Privacy Policy at www.gilead.com.

  • Gilead Sciences reserves the right to terminate, rescind, revoke, or modify the Coupon at any time without notice.

  • IMPORTANT SAFETY INFORMATION

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

    EPCLUSA can cause serious side effects, including:

  • Hepatitis B virus reactivation: Before starting EPCLUSA treatment, your healthcare provider will do blood tests to check for hepatitis B infection. If you have ever had hepatitis B, the hepatitis B virus could become active again during and after treatment with EPCLUSA. This may cause serious liver problems including liver failure and death. If you are at risk, your healthcare provider will monitor you during and after taking EPCLUSA.

  • What should I tell my healthcare provider before taking EPCLUSA?

  • Tell your healthcare provider about all of your medical conditions, including if you have ever had hepatitis B infection, liver problems other than hepatitis C infection, or a liver transplant; if you have kidney problems or are on dialysis; if you have HIV; 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 or pass into your breast milk.

    Tell your healthcare provider about all of your medical conditions, including if you have ever had hepatitis B infection, liver problems other than hepatitis C infection, or a liver transplant; if you have kidney problems or are on dialysis; if you have HIV; 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 or pass into your breast milk. 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.

  • What are the possible side effects of EPCLUSA?

    Serious side effects may also include:

  • Slow heart rate (bradycardia): EPCLUSA, when taken with amiodarone (Cordarone®, Nexterone®, Pacerone®), a medicine used to treat certain heart problems, may cause 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. 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.

    The most common side effects of EPCLUSA include headache and tiredness. The most common side effects of EPCLUSA when used with ribavirin in adults with decompensated cirrhosis are tiredness, low red blood cells, nausea, headache, trouble sleeping, and diarrhea.

    Tell your healthcare provider if you have any side effect that bothers you or does not go away.

    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.

    What is EPCLUSA?

    EPCLUSA is a prescription medicine used to treat adults with chronic (lasting a long time) hepatitis C (Hep C) genotype 1-6 infection with or without cirrhosis (compensated).

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

    Please see Important Facts about EPCLUSA including Important Warning.

    Tap for Important Safety Information about EPCLUSA including Important Warning on hepatitis B reactivation.