TEPMETKO

CoverOne Patient Assistance Program Patient Guide: How to Get TEPMETKO (tepotinib) at Low or No Cost

About TEPMETKO

TEPMETKO (tepotinib) is a prescription medication used to treat certain types of non-small cell lung cancer. Because this medication can be expensive, EMD Serono offers the CoverOne Patient Assistance Program to help eligible patients access TEPMETKO at no charge when they meet specific criteria.

Who Qualifies for This Program

You may be eligible for the CoverOne Patient Assistance Program if you:

• Are a U.S. resident or resident of Puerto Rico
• Are uninsured or underinsured (meaning your insurance does not adequately cover TEPMETKO)
• Meet the program's income eligibility requirements
• Have a valid prescription for TEPMETKO from your healthcare provider
• Are not currently covered by Medicare (though you may reapply after December 31st of the current calendar year)

The program is designed specifically for patients without adequate insurance coverage. If you have commercial insurance that covers TEPMETKO, you may instead qualify for the CoverOne Co-Pay Assistance Program, which helps reduce your out-of-pocket costs up to $15,000 per calendar year.

Income Eligibility

While specific income thresholds are not publicly listed, the program requires that you demonstrate financial need. Income eligibility is determined on a case-by-case basis and considers your household income from all sources.

Insurance Requirements

To qualify for the Patient Assistance Program, you must be:

• Uninsured (no health insurance coverage), OR
• Underinsured (have insurance that does not adequately cover TEPMETKO)

If you have Medicare coverage, you are not eligible for this program during the current calendar year. However, your eligibility will automatically expire on December 31st, and you can submit a new application for the following year.

If you have commercial insurance, contact CoverOne to learn about the Co-Pay Assistance Program instead.

Step-by-Step Application Process

Step 1: Gather Required Documents

Before starting your application, collect the following:

• Your most recent tax return (IRS Form 1040) or other proof of household income
• Your prescription for TEPMETKO from your healthcare provider
• Proof of residency (such as a utility bill or lease agreement)
• Your contact information (phone, email, mailing address)

Step 2: Complete the CoverOne Enrollment Form

Your healthcare provider can help you complete the official CoverOne TEPMETKO Enrollment Form. This form asks for:

• Your personal and medical information
• Your household size and income details
• Your insurance status
• Your healthcare provider's information and prescription details

Step 3: Submit Your Application

You have two options for submitting your completed form:

• By Fax: Send your completed enrollment form and supporting documents to CoverOne at 1-800-214-7295 or 1-844-501-0062
• By Phone: Call 1-844-662-3631 (Monday-Friday, 8:00 AM - 8:00 PM ET) to speak with a CoverOne Access Navigator who can guide you through the process

Make sure your form is complete and signed by both you and your healthcare provider. An incomplete form may delay your enrollment.

Step 4: Await Eligibility Determination

After submitting your application, a CoverOne Access Navigator will contact you as soon as possible to notify you of your eligibility status. Keep your contact information current so they can reach you.

Timeline and Medication Delivery

While specific processing times are not publicly stated, CoverOne aims to notify you of your eligibility status promptly after receiving your complete application. Once approved, TEPMETKO will be shipped directly to you or your healthcare provider.

To avoid treatment delays, submit your application as soon as possible after receiving your prescription.

What Happens If Your Application Is Denied

If you do not qualify for the Patient Assistance Program, CoverOne can help you explore other options:

• Co-Pay Assistance Program: If you have commercial insurance, you may qualify for assistance with co-pays and co-insurance
• Bridge Program: If your insurance is delaying coverage approval, you may qualify for temporary medication access while your claim is being reviewed
• Reimbursement Support: CoverOne can help verify your insurance benefits and assist with prior authorization or appeals

Contact CoverOne to discuss alternative assistance options.

Reauthorization and Renewal

Your eligibility for the Patient Assistance Program must be renewed annually. If you currently have Medicare coverage, your eligibility automatically expires on December 31st of the current calendar year. You will need to submit a new CoverOne enrollment form to continue receiving assistance in the following year.

CoverOne will notify you when it is time to reauthorize your enrollment.

Important Disclaimer

This guide provides general information about the CoverOne Patient Assistance Program for TEPMETKO. Program eligibility, benefits, and terms are subject to change. EMD Serono does not guarantee coverage or reimbursement. For complete and current program information, visit CoverOne.com or contact CoverOne directly at 1-844-662-3631. Always verify your specific eligibility and coverage with CoverOne before beginning treatment.