HERZUMA

Indicated For

HER2-positive breast cancer

About This Medication

# HERZUMA Cost Support Program Patient Guide: How to Get HERZUMA (trastuzumab-pkrb) at Low or No Cost HERZUMA (trastuzumab-pkrb) is a biosimilar to Herceptin® used to treat certain HER2-positive breast cancers and gastric cancers, and the **HERZUMA Cost Support Program** from Teva Pharmaceuticals USA, Inc. helps eligible patients reduce out-of-pocket costs for this medication.[1][3][5] This guide explains eligibility, application steps, and support options in simple terms to help you access treatment affordably. ## About HERZUMA (trastuzumab-pkrb) **HERZUMA** is an injectable biosimilar medication that targets HER2-overexpressing proteins in cancer cells, helping to slow or stop their growth.[3][5][7] It's FDA-approved for: - **Adjuvant (post-surgery) breast cancer**: For HER2-overexpressing node-positive or node-negative breast cancer (ER/PR-negative or with high-risk features), used with chemotherapy like doxorubicin, cyclophosphamide, paclitaxel/docetaxel, or docetaxel/carboplatin, or as a single agent after other therapies.[3] - **Metastatic breast cancer**: Combined with paclitaxel for first-line treatment or as a single agent after prior chemotherapy.[5] Patients must be selected using an FDA-approved companion diagnostic test for HER2 status.[7] Administered by a healthcare provider via IV infusion, typically in a clinic or hospital, it's not a self-injectable drug.[1][4] As a biosimilar, HERZUMA offers similar efficacy and safety to the reference product at potentially lower costs, supporting broader access.[5][7] ## Who Qualifies for the Program? The program primarily supports **commercially insured patients** (private insurance, including medical benefit plans) prescribed HERZUMA, helping cover out-of-pocket costs like copays or deductibles.[1][2][4] Key points: - Available for patients 18+ with a valid prescription.[6] - Helps reduce costs to **as little as $0 per fill**, up to program limits.[2] - **Maximum benefit**: $10,600 for 2026 (valid until 12/31/2026); does not exceed your insurance's yearly out-of-pocket max.[1] - Also mentioned for uninsured/underinsured, but core eligibility is commercial insurance; contact program for details.[2] **Not eligible**: Medicare, Medicaid, other government/federally funded insurance, or cash-paying patients without commercial coverage.[2][4] If you switch to government insurance, benefits end.[2] ## Income Eligibility This program does **not use income thresholds**; eligibility focuses on insurance type and out-of-pocket costs for HERZUMA.[2][4] No financial screening is required, making it accessible for commercially insured patients regardless of income, as long as you meet insurance rules.[1][6] | Eligibility Factor | Details | |--------------------|---------| | **Insurance Type** | Commercial/private only; no Medicare/Medicaid[2][4] | | **Income Limits** | None specified[program details] | | **Age** | 18+ years old[6] | | **Prescription** | Valid HERZUMA prescription required[1][4] | | **Annual Cap** | $10,600 max assistance (2026); patient pays beyond[1][2] | ## Insurance Requirements You need **commercial insurance covering HERZUMA through a medical benefit plan** (not pharmacy benefit).[1][4] Program covers eligible HERZUMA out-of-pocket costs only—not administration fees, office visits, or tests.[4] Submit proof of coverage, EOB showing your costs, and claim form.[4] All insurance-mandated steps (e.g., prior auth) must be met.[2] Teva CORE offers help with benefits verification, prior auth, and appeals.[5][8] ## Step-by-Step Application Process 1. **Get Prescribed**: Obtain a valid HERZUMA prescription from your doctor.[1] 2. **Confirm Coverage**: Ask your provider to verify insurance covers HERZUMA via Teva CORE (tevacore.com).[5][8] 3. **Contact Program**: Call **(844) 355-1499** to start—application is by phone only.[program details] 4. **Gather Documents**: - Valid HERZUMA prescription - Proof of insurance - EOB detailing out-of-pocket costs - Insurance claim form (CMS-1500, UB04, or electronic)[program details][4] 5. **Submit Claims**: Within **180 days** of EOB/insurance payment; program reimburses eligible costs.[2][4] Covers up to 90-180 days prior to enrollment.[2] 6. **Receive Assistance**: Auto-enrolls for next year unless you opt out or insurance changes.[2][4] Your doctor or clinic often handles claims submission.[4] ## Timeline and Delivery - **Processing**: Not specified; submit promptly after each fill.[2] - **Reimbursement**: Paid after EOB review, within program terms.[4] - **Delivery**: HERZUMA is administered in-clinic; program covers your cost share, not shipping.[1] - **Duration**: Benefits until 12/31/2026 or caps reached; reauthorization needed for ongoing therapy.[1][program details] Expect support from Teva CORE for navigation.[8] ## Alternatives if Denied or Ineligible - **Teva Cares Foundation PAP**: Free HERZUMA for low-income/uninsured meeting strict criteria (tevacaress.org); updates as of 1/31/2025.[10] - **Other Biosimilars**: Discuss alternatives like other trastuzumab biosimilars with your doctor. - **Appeals**: Use Teva CORE for insurance appeals.[5] - **General Aid**: State programs, nonprofits, or manufacturer bridges. ## Important Disclaimer This guide is for informational purposes based on available program details as of 2026 and is not medical/financial advice. Eligibility/terms can change; **always verify with (844) 355-1499** or herzuma.com.[1][2] Teva may adjust benefits at discretion. Consult your doctor for treatment suitability. Not for government-insured patients.[4] Word count: 942.

Program information last verified: March 30, 2026