Terms and Conditions

By using the Esbriet $5 Co-pay Program, the patient acknowledges and confirms that, at the time of usage, (s)he is currently eligible and meets the criteria set forth in the terms and conditions described.

This Co-pay Program is valid ONLY for patients with commercial (private or non-governmental) insurance who are taking the medication for a Food and Drug Administration (FDA)-approved indication. Patients using Medicare, Medicaid, or any other government-funded program to pay for their medications are not eligible. Patients who start utilizing their government coverage during their enrollment period will no longer be eligible for the program.

This Co-pay Program is not health insurance or a benefit plan. Distribution or use of the Co-pay Program does not obligate use or continuing use of any specific product or provider. Patient or guardian is responsible for reporting the receipt of all Co-pay Program benefits or reimbursement received to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the Co-pay Program, as may be required.

The Co-pay Program is not valid for medications the patient receives for free or that are eligible to be reimbursed by private insurance plans or other health care or pharmaceutical assistance programs (such as Genentech® Access to Care Foundation (GATCF) or any other charitable organization) that reimburse the patient in part or for the entire cost of his/her Genentech medication. Patient, guardian, pharmacist, prescriber, and any other person using the Co-pay Program agree not to seek reimbursement for all or any part of the benefit received by the recipient through the offer.

The Co-pay Program will be accepted by participating pharmacies, physician offices, or hospitals. To qualify for the benefits of this Co-pay Program, the patient may be required to pay out-of-pocket expenses for each treatment. Once enrolled, this Co-pay Program will not honor claims with date of service or medication dispensing that precede program enrollment by more than 120 days. This Co-pay Program is only available with a valid prescription and cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription. Use of this Co-pay Program must be consistent with all relevant health insurance requirements and payer agreements. Participating patients, pharmacies, physician offices, and hospitals are obligated to inform third-party payers about the use of the Co-pay Program as provided for under the applicable insurance or as otherwise required by contract or law. The Co-pay Program may not be sold, purchased, traded, or offered for sale, purchase, or trade. The Co-pay Program is limited to 1 per person during this offer period and is not transferable. Program eligibility period is contingent upon patient's ability to meet and maintain all requirements as set forth by the program. Genentech will periodically verify eligibility and will terminate patients without obligation to pay claims if change to status is detected. This program is not valid where prohibited by law, and shall follow state restrictions in relation to AB-rated generic equivalents where applicable (e.g. MA, CA).

The patient or their guardian must be 18 years or older to receive Co-pay Program assistance. This Co-pay Program is (1) void where prohibited by law; (2) only valid in the United States and Puerto Rico; and (3) only valid for Genentech products. Health care providers may not advertise or otherwise use the program as a means of promoting their services or Genentech's products to patients. Genentech reserves the right to rescind, revoke, or amend the program without notice at any time.

Indication and Important Safety Information

About Esbriet

Esbriet is a prescription medicine used to treat people with a lung disease called idiopathic pulmonary fibrosis (IPF).

It is not known if Esbriet is safe and effective in children.

Select Important Safety Information

Before you take Esbriet, tell your doctor about all of your medical conditions, including if you:

  • have liver problems
  • have kidney problems
  • are a smoker
  • are pregnant or plan to become pregnant. It is not known if Esbriet will harm your unborn baby.
  • are breastfeeding or plan to breastfeed. It is not known if Esbriet passes into your breast milk. You and your doctor should decide if you will take Esbriet or breastfeed.

Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

What should I avoid while taking Esbriet?

  • Sunlight. Esbriet can make your skin sensitive to the sun and the light from sunlamps and tanning beds. You could get a severe sunburn. Use sunscreen (SPF 50) and wear a hat and clothes that cover your skin if you have to be in sunlight. Talk to your doctor if you get sunburn or a rash.
  • Taking Esbriet with other medicines that can make your skin sensitive to the sun, the light from sunlamps and tanning beds.
  • Smoking. Smoking may affect how well Esbriet works.

What are the possible side effects of Esbriet?

Esbriet may cause serious side effects, including:

  • liver problems. Call your doctor right away if you have unexplained symptoms such as yellowing of your skin or the white part of your eyes (jaundice), dark or brown (tea-colored) urine, pain on the upper right side of your stomach area (abdomen), bleeding or bruising more easily than normal, or feeling tired. Your doctor will do blood tests to check how your liver is working during your treatment with Esbriet.
  • sensitivity to sunlight (photosensitivity) and rash. See "What should I avoid while taking Esbriet?"
  • stomach problems. Esbriet may cause stomach problems such as nausea, vomiting, diarrhea, indigestion, heartburn, and stomach pain. Tell your doctor right away if your stomach problems get worse or do not go away. Your doctor may need to change your dose of Esbriet.

The most common side effects of Esbriet include feeling tired, insomnia, upper respiratory tract infections, sinusitis, headache, dizziness, decreased weight and decreased or loss of appetite.

These are not all the possible side effects of Esbriet.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. You may also report side effects to Genentech at 1-888-835-2555.

Please see full Prescribing Information, including Patient Information, for additional important safety information.