CIMERLI® patient and provider support
CIMERLI Solutions™ helps ease administrative burdens and streamlines patient access
Find a simplified suite of patient assistance, industry-leading electronic services, and office support to ensure successful access and reimbursement.Access the CIMERLI Solutions™ Portal (opens in a new tab)
CIMERLI® permanent Q-code
- 0.5 mg:
5 billable units,
- 0.3 mg:
3 billable units,
Comprehensive reimbursement services to support your practice
CIMERLI Solutions™, part of the Coherus Solutions™ family of support services, offers reimbursement solutions you can count on:
Benefit Verification Support
Determine treatment coverage through electronic medical benefit verification
Prior Authorization Support
Ease administration burden with support for required prior authorizations or predeterminations*
Coding and Billing Support
Sample coding and billing information is available to help facilitate appropriate claims submission†
Patient Financial Assistance
CIMERLI® may be available to your patients at no cost‡
Resources to help you confirm the medical necessity of CIMERLI® and appeal denied claims§
Assistance with product replacement
Coding Reference Guide (opens in a new tab)
*If your patient's request for required authorizations isn't granted, your field reimbursement manager can work with you to determine next steps.
†Correct coding is the responsibility of the provider submitting the claim for the item or service. Please check with the payer to verify codes and special billing requirements. CIMERLI Solutions™ does not make any representation or guarantee concerning reimbursement or coverage for any service or item.
‡Eligibility requirements, type of assistance, and application process varies.
§CIMERLI Solutions™ cannot complete or submit appeals on your behalf.
CO-PAY SAVINGS PROGRAM
Your patients may pay as little as $0 for CIMERLI®
The Co-Pay Savings Program may cover out-of-pocket costs associated with CIMERLI® and the injection
procedure for eligible patients with commercial insurance.*
Maximum annual benefit of $15,000 for
drug costs per calendar year.†
Maximum annual benefit of $1,000 for
injection costs per calendar year.†
*Drug and Injection Co-Pay Eligibility Criteria:
- Be prescribed CIMERLI® for a medically appropriate purpose consistent with its FDA-approved labeling within 180 days of program enrollment
- Have commercial (private or non-governmental) health insurance that covers the medication costs of CIMERLI®
- Over the age of 18 years old and a US resident
- For Administration: Not a resident or get treatments in Minnesota, Rhode Island
- If a resident of Massachusetts, injection administration may only be paid directly to the patient. Additional information may be required
- Not covered by any federal, state, or government-funded healthcare program, such as Medicare, Medicare Advantage, Medicare Part D, Veterans Affairs, Department of Defense, or TRICARE
- Not seek reimbursement from any third party, including payers, charitable foundations, or flexible spending account (FSAs) or healthcare savings accounts (HSAs) for all or any part of the benefit received by Coherus through this program
- Other restrictions apply, see Terms & Conditions†
- It is not valid for cash-paying patients or where prohibited by law
- CIMERLI® co-pay program subject to change or discontinuation without notice. This is not health insurance
†Terms & Conditions
Coherus’s Drug Co-pay Program and Injection Co-pay Program are different programs with unique eligibility for each. Patients must enroll separately as needed. To receive co-pay assistance for drug or administration co-pay costs, the provider, patient, or caregiver must enroll eligible individual within 180 days after the date of service for which the subsidy is sought.
Participating patients, pharmacies, physician offices and hospitals may use Coherus’s patient services web portal or send completed enrollment forms to 1-877-226-6370 to enroll patients.
Under the CIMERLI® Drug Co-Pay program, if a patient incurs a co-pay obligation for the cost of CIMERLI®, and meets all eligibility requirements, Coherus shall subsidize the cost of drug up to $15,000 per calendar year.
Under the CIMERLI® Injection Co-Pay program, if a patient incurs a co-pay obligation for the administration of CIMERLI®, and meets all eligibility requirements, Coherus shall subsidize the cost of administration up to $1,000 per calendar year.
The program benefits will reset every January 1st. Re-enrollment in the programs is required at regular intervals. Patients may participate in the programs as long as patient re-enrolls as required by Coherus BioSciences and continues to meet all of the eligibility requirements for each program during participation in the programs. After reaching the maximum benefit for either program, the patient will be responsible for all remaining out-of-pocket expenses. The amount of each of the program’s benefits cannot exceed the patient’s out-of-pocket expenses for the cost of the drug or administration fees associated with CIMERLI®.
The programs are not valid if the costs are eligible to be reimbursed in their entirety by private insurance plans or other programs. The programs are not valid for patients receiving assistance from any other third party, including charitable organizations, if assistance is for the same expenses covered by the programs. The administration assistance cannot be combined with any other rebate, free trial, or similar offer for the medication or administration of the product unless otherwise permitted by Coherus. These programs are not health insurance or a benefit plan.
All participants are responsible for reporting the receipt of all program benefits as required by any insurer or by law. The programs are only valid in the United States and U.S. Territories and otherwise void where prohibited by law, including in Minnesota and Rhode Island. (In Massachusetts special conditions apply.) The injection administration co-pay may only be paid directly to the patient. Additional information may be required to facilitate payment directly to the patient. Program benefits may not be sold, purchased, traded or offered for sale.
The programs do not obligate use of any specific product or provider. Healthcare providers may not advertise or otherwise use the programs as a means of promoting their services or Coherus products to patients. Coherus reserves the right to rescind, revoke, or amend the program without notice at any time.
Coherus’s Co-Pay Savings Program covers the cost of medication and administration and does not cover costs associated with the office visit.
Financial assistance for greater patient access to quality treatment
Whether your patients are commercially insured, uninsured, underinsured, or on Medicare, CIMERLI Solutions™
has assistance programs that may help ease payment concerns.
Patient assistance program
Uninsured or underinsured patients may receive CIMERLI® at no cost
CIMERLI® may be available to your patients at no cost if they have no insurance or if their insurance does not cover CIMERLI® or another drug in this class.‡
‡Patient Assistance Eligibility
Patients must be either: (a) uninsured; (b) functionally underinsured§; or (c) traditional Medicare FFS insured patient(s) that demonstrate financial hardship and cannot afford their cost-sharing obligation as evidenced by a signed attestation from their provider.
Additionally, patients must
- Have an adjusted annual household income of ≤500% of Federal Poverty Level (FPL)
- Complete and sign consent form and, when applicable, provide income documentation
- Be under the care of a U.S. licensed provider, and receive CIMERLI® in an established practice located in the U.S. incident to the prescribing physician’s professional services in the outpatient setting
- Be a U.S. resident of any U.S. state
- Have diagnosis and dosing that are consistent with FDA-approved indication for CIMERLI®
- Not have any other financial support options
§To be considered functionally underinsured, the patient does not have coverage for CIMERLI® or any other anti-VEGF or ranibizumab product.
Independent co-pay foundations
Assistance with out-of-pocket costs
Charitable organizations may be able to provide financial assistance if your patients have commercial insurance or governmental insurance, including Medicare and Medicaid.‖
Your patient can contact these independent foundations directly, or a CIMERLI Solutions™ patient access specialist can help determine if they are eligible at 1-844-483-3692.
‖Independent foundations have their own rules for eligibility. Coherus Biosciences has no involvement or influence in independent foundation decision-making or eligibility criteria.
How to access the CIMERLI Solutions™ Portal
Accessing patient and provider support through the CIMERLI Solutions™ Portal starts with registering an account.
The CIMERLI Solutions™ Brochure
provides step-by-step instruction for:
- Registering your account
- Setting up users
- Optimizing patient management