Margenza

Indicated For

HER2-positive metastatic breast cancer

About This Medication

# TerSera SupportSource for MARGENZA Patient Assistance Program Patient Guide: How to Get Margenza (margetuximab-cmkb) at Low or No Cost Margenza (margetuximab-cmkb) is a prescription medication used to treat **HER2-positive metastatic breast cancer** in adults who have received prior anti-HER2 therapies or one or more chemotherapy regimens. The **TerSera SupportSource for MARGENZA Patient Assistance Program** helps qualifying patients get this important treatment at no cost if they meet financial and insurance criteria.[1][2] ## About Margenza and Why Access Matters **Margenza** is given as an intravenous (IV) infusion, typically in combination with chemotherapy, at an outpatient facility like a hospital, clinic, or doctor's office. The first dose takes about 120 minutes; if tolerated, later doses can be as short as 30 minutes. It's administered after chemotherapy. Common side effects include infusion reactions (fever, chills, nausea), diarrhea, fatigue, vomiting, and decreased appetite. Serious risks include **left ventricular dysfunction** (monitor heart function) and severe infusion reactions—tell your doctor immediately about shortness of breath, swelling, irregular heartbeat, or sudden weight gain.[2][4] Access to Margenza can be challenging due to high costs without assistance. This program from **TerSera** provides free medication to eligible patients, ensuring you can focus on treatment rather than finances. It's separate from the copay program, which helps commercially insured patients with out-of-pocket costs up to $26,000/year.[1][5] ## Who Qualifies? To qualify, you must: - Have a prescription for Margenza for an **FDA-approved use** (HER2+ metastatic breast cancer after prior treatments).[2] - Be a **permanent legal U.S. resident**.[2] - Demonstrate **financial need** (specific income limits not publicly detailed; program assesses household income).[2] - Meet **insurance criteria**: Uninsured, or insurance doesn't cover Margenza. **Medicare Part D patients** may qualify if **not eligible for Low-Income Subsidy (LIS)** and have spent **at least 3% of annual household income** on prescriptions.[2] **Note**: You cannot be enrolled in government programs that conflict with PAP rules, and Medicare patients must agree not to seek reimbursement or TrOOP credit for PAP-provided drug.[2] ## Income Eligibility Breakdown The program requires proof of financial need but does not publish fixed Federal Poverty Level (FPL) percentages or household size thresholds online. Eligibility is determined case-by-case based on income documentation. Medicare Part D patients face extra hurdles: no LIS eligibility and 3% income spent on meds. | Household Type | Income Threshold | FPL % | Notes | |---------------|------------------|-------|-------| | Individual | Case-by-case | Not specified | Proof of income required; Medicare Part D: ≥3% income on prescriptions, no LIS [2] | | Couple | Case-by-case | Not specified | Household income assessed [2] | | Family of 3 | Case-by-case | Not specified | Full household documentation needed [2] | | Family of 4 | Case-by-case | Not specified | Program reviews all finances [2] | Contact the program at **(844) 633-6469** for a pre-screening to estimate eligibility.[1][2] ## Insurance Requirements - **Uninsured patients**: Eligible if financially needy.[2] - **Insured patients**: Coverage must deny Margenza (appeal denial required); insured patients generally ineligible unless exception applies.[2] - **Medicare Part D**: Eligible only if not on LIS, spent ≥3% household income on prescriptions, and agree to notify plan (drug is outside Part D benefit—no reimbursement or TrOOP).[2] - Exclusions: Cannot participate if on Medicaid, other federal programs, or if insurance fully covers.[5][10] Your doctor must confirm insurance denial if applicable.[2] ## Step-by-Step Application Process 1. **Talk to your doctor**: Discuss if Margenza is right and confirm prescription for FDA-approved use. They complete the prescriber section.[2] 2. **Call for help**: Dial **1-844-633-6469** (1-844-MED-MGNX), Mon-Fri 8 AM-7 PM ET. Support specialists guide enrollment, review eligibility, and answer questions.[1] 3. **Download form**: Get the **MARGENZA Patient Assistance Program Enrollment Form** from margenza.com/support-and-resources or via phone.[1][2] 4. **Complete together**: You and your doctor fill it out—include treatment site (outpatient/hospital), ICD-10 code, product delivery preference (proactive or replacement).[2] 5. **Gather documents**: - **Completed enrollment form** (signed by you and doctor).[2] - **Proof of residency** (e.g., utility bill, driver's license).[2] - **Proof of income** (tax returns, pay stubs, 3% spend proof for Medicare).[2] - **Insurance information** (card, denial letter if insured).[2] 6. **Submit by fax**: Fax to the number on the form (typically program-specific; confirm via phone). Application method is fax.[2] 7. **Follow up**: Program contacts you; doctor may get updates.[2] Work with your oncology team—nurses or case managers often assist.[1] ## Timeline and Delivery Processing time not specified—call for updates. Once approved, Margenza ships **directly to your outpatient treatment facility** (hospital/clinic/prescriber's office), not home. Choose proactive (pre-arrival) or replacement (post-dose) supply. **Reauthorization required** for continued therapy; doctor notifies if criteria change.[2] Expect coordination with your infusion center. Track via phone support.[1] ## Alternatives if Denied - **Copay Assistance Program**: For commercial insurance covering Margenza but high copays (up to $26,000/year max). Fax separate form.[1][5] - **Foundation/charity help**: Program connects you (e.g., CancerCare, Patient Access Network).[1] - **Appeal insurer**: Doctor submits prior auth/appeal.[2] - **Other PAPs**: Check rxassist.org or needymeds.org for breast cancer support.[10] - **No biosimilars** available for Margenza (unique Fc-enhanced antibody).[4] **Denial reasons**: Income too high, insurance covers, missing docs, LIS enrollment. Reapply if circumstances change.[2] ## Important Disclaimer This guide summarizes publicly available info as of latest data. **Program rules can change**—TerSera may suspend, limit, or end without notice. Always verify with **1-844-633-6469** or margenza.com. Not legal/medical advice; consult your doctor. Medicare patients: PAP drug can't count toward True Out-of-Pocket (TrOOP) or deductible. Report side effects to FDA at 1-800-FDA-1088.[1][2] **Word count: 1028**

Program information last verified: March 25, 2026