I. ELIGIBILITY
*Eligibility Criteria: Subject to program limitations and terms and conditions, the Amgen
Edge® program is open to a patient who meets the following qualifications:
- Has a prescription for an Amgen medication covered under the AmgenEdge® program;
- Has commercial insurance that:
- Has been identified as ineligible for benefits under the Co-Pay program of the Amgen medication because all amounts paid on the patient’s behalf by manufacturer for out-of-pocket assistance do not accumulate towards the patient’s cost-sharing obligations; and
- Will apply all amounts paid on the patient’s behalf by the AmgenEdge® program, or other need-based out-of-pocket assistance programs, towards the patient’s cost-sharing obligations.
- Has demonstrated financial need based on an annual household income that falls at or below 500% of the Federal Poverty Level as provided in the HHS Poverty Guidelines found at https://aspe.hhs.gov/poverty-guidelines.
This offer is not valid for patients whose prescription for an Amgen medication covered under the AmgenEdge® program is paid for in whole or in part by Medicare, Medicaid, or any other federal or state healthcare programs. It is not valid for cash paying patients or where prohibited by law. A patient is considered cash-paying where the patient has no insurance coverage for a medication covered under the AmgenEdge® program or where the patient has commercial or private insurance but Amgen in its sole discretion determines the patient is effectively uninsured because such coverage does not provide a material level of financial assistance for the cost of the medication covered under the AmgenEdge® program. This offer is only valid in the United States, Puerto Rico, and the US territories.
II. PROGRAM BENEFITS & PROGRAM DETAILS
The AmgenEdge® card may be used to cover the patient’s out-of-pocket expenses for the medication covered under the AmgenEdge® program as long as the patient’s commercial health plan continues to allow this support as intended.
The Amgen
Edge® program does not cover out-of-pocket costs for any needs-based patient whose commercial insurance plan refuses to apply need-based manufacturer out-of-pocket assistance payments, such as Amgen
Edge® assistance, to satisfy the patient’s cost-sharing obligations (copayment, deductible or coinsurance, collectively, “OOP”) for medications covered under the Amgen
Edge® program. Patients with these plan limitations are not eligible for the Amgen
Edge® program. Patients who believe their commercial insurance plan may not allow manufacturer OOP support for needs-based patients should contact the Amgen
Edge® administrator at
877-362-7352. In order to confirm patient eligibility, Amgen will notify the patient’s healthcare plan in writing that a patient has qualified for Amgen
Edge® and that the patient will receive needs-based assistance unless the healthcare plan notifies Amgen that it refuses to allow needs-based OOP support to accumulate without adjustments to the patient’s OOP obligations. If and when such notification is received from the Plan Administrator, Amgen will remove the patient from the Amgen
Edge® program.
If at any time, a patient begins receiving coverage for medications under any federal, state, or government healthcare program (including but not limited to Medicare, Medicaid, TRICARE, Department of Defense, or Veteran’s Affairs programs), the patient will no longer be able to use this card and you must contact
AmgenEdge® at 877-362-7352, 8:00am–8:00pm ET, Monday – Friday to stop your participation in this program.
Patients may not seek reimbursement for the value received from the Amgen
Edge® program from any third-party payers, including a flexible spending account or healthcare savings account. Participating in this program means that you are ensuring you comply with any required disclosure regarding your participation in the Amgen
Edge® program of your insurance carrier or pharmacy benefit manager. Restrictions may apply. Offer subject to change or discontinuation without notice.
This is not health insurance.
Maximum Program Benefit, Patient Benefits May Change, End or Vary Without Notice: The Amgen
Edge® program provides up to a
Maximum Program Benefit (based upon the medication covered by the Amgen
Edge® program) to reduce a patient’s out-of-pocket medication costs that Amgen will provide per patient for each calendar year, which must be applied to the patient’s out-of-pocket prescription costs (co-pay, deductible, or co-insurance). Each patient is responsible for costs above these amounts.
Patients may use the card every time they fill their prescription for the
Amgen medication covered under the AmgenEdge® program. Benefits reset each calendar year. Re-enrollment in the program is required at regular intervals. Patients may participate in the program provided the patient re-enrolls as required by Amgen and continues to meet all of the program’s eligibility requirements during participation in the program. Patients can enroll by calling
877-362-7352.