Cimzia

Indicated For

Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis, Crohn's Disease, Plaque Psoriasis, Non-radiographic Axial Spondyloarthritis

About This Medication

# UCB Patient Assistance Program Patient Guide: How to Get Cimzia at Low or No Cost ## About This Program The UCB Patient Assistance Program helps eligible patients access **Cimzia (certolizumab pegol)** at no cost or reduced cost if they cannot afford their medication. Cimzia is a prescription medication used to treat inflammatory conditions such as rheumatoid arthritis, Crohn's disease, and psoriasis. If you have a valid prescription from a U.S.-licensed healthcare provider and meet the program's eligibility requirements, you may qualify for assistance. ## Who Qualifies for This Program? You may be eligible for the UCB Patient Assistance Program if you meet ALL of the following requirements: - **Residency**: You are a resident of the United States, the District of Columbia, or a U.S. Territory - **Insurance Status**: You are uninsured, underinsured, or insured but experiencing significant financial hardship despite having insurance coverage - **Valid Prescription**: You have a current, valid prescription for Cimzia from a U.S.-licensed healthcare provider - **Income Eligibility**: Your household income meets the program's threshold (specific limits are subject to change and will be verified during the application process) **Important**: This program is not available to patients whose medications are covered by government-funded programs such as Medicaid or Medicare. However, if you are enrolled in a Medicare Part D plan, you may still be eligible to apply. ## Income Eligibility The UCB Patient Assistance Program uses household income as a key eligibility factor. While specific income thresholds are not publicly detailed, the program generally serves patients who are uninsured or underinsured with limited financial resources. Income limits are subject to change at UCB's discretion. | Income Category | Eligibility Status | |---|---| | Uninsured with any household income | Likely eligible | | Underinsured with financial hardship | Likely eligible | | Insured with significant hardship | May be eligible | | Government program coverage (Medicaid) | Not eligible | During your application, you will need to provide proof of your household income. If you receive no income, you can submit a signed letter explaining this instead. ## Insurance Requirements You **do not need to be uninsured** to qualify. The program accepts applications from: - Uninsured patients - Underinsured patients (those with limited prescription coverage) - Insured patients experiencing significant financial hardship - Patients with certain Medicare Part D plans The program **cannot assist** if your medication is covered by Medicaid or traditional Medicare (Part A or B). However, if you have a Medicare Part D prescription drug plan, you may still qualify. ## How to Apply: Step-by-Step ### Step 1: Gather Required Documents Before starting your application, collect the following: - Proof of household income (recent tax return, pay stubs, benefit statements, or a signed letter if you have no income) - Proof of residency (utility bill, lease agreement, or government-issued ID) - Your valid prescription for Cimzia from your healthcare provider - Your contact information (phone number, mailing address, date of birth) ### Step 2: Complete the Patient Section Fill out the patient section of the UCB Patient Assistance Program Application with your personal information, including: - Full name - Date of birth - Mailing address - Phone number - Household income information - Insurance status Sign and date the patient section. ### Step 3: Have Your Healthcare Provider Complete the Prescriber Section Give the application form to your physician or healthcare provider. They will need to: - Verify your prescription for Cimzia - Complete the prescriber section of the form - Sign and date the form ### Step 4: Submit Your Application Mail your completed application along with all required documents to: **UCB, Inc.** 1330 Enclave Parkway, Suite 125 Houston, TX 77077 Alternatively, you can fax your application to **(855) 880-5262**. You can also contact **UCBCares** for assistance: - **Phone**: (844) 599-CARE (2273) - **Email**: ucb-pap@cardinalhealth.com ### Step 5: Await Approval Notification UCB will verify your information and contact you about your eligibility status. Once approved, your medication will be shipped to you or your physician's office. ## Timeline and Medication Delivery The exact processing time for applications is not specified by UCB, but you should submit your application promptly to avoid delays. Once approved, your Cimzia will be **shipped directly to you or your healthcare provider's office**. Approvals are typically valid for up to **12 months**, after which you will need to reapply. ## What If Your Application Is Denied? If you do not meet the minimum eligibility requirements, you may still have options. Contact **UCBCares at (844) 599-CARE (2273)** to explore other financial resources or assistance programs that may be available to you. ## Reauthorization and Refills Your assistance approval is valid for approximately **12 months**. Before your approval expires, you will need to reapply to continue receiving assistance. UCB will notify you when reauthorization is required. If your circumstances change (such as a change in income or insurance status), you should update your application promptly. ## Important Reminders - **No application fee**: There is no cost to apply for this program. - **No medical documentation required**: Do not submit medical records, chart notes, or additional medical documentation unless specifically requested. - **Authorized representatives**: If you cannot complete the application yourself, an authorized representative (such as a family member or caregiver) can apply on your behalf. If they have power of attorney, include supporting documentation. - **Program changes**: The UCB Patient Assistance Program's eligibility requirements and business rules are subject to change at any time without notification. ## Disclaimer This guide provides general information about the UCB Patient Assistance Program for Cimzia. Program eligibility, requirements, and benefits are subject to change. For the most current and accurate information, contact UCBCares directly at (844) 599-CARE (2273) or visit the UCB website. This guide is not a guarantee of eligibility or assistance. All applications are subject to verification and approval by UCB.

Program information last verified: March 25, 2026