Dosage & Administration Biomarker testing Drug label Prior authorization Pharmacy Financial assistance

Perjeta

(pertuzumab)

Perjeta 420 MG in 14 ML Injection

Dosage & administration

* For intravenous infusion only. Do not administer as an intravenous push or bolus.
* HER2 testing: Perform using FDA-approved tests by laboratories with demonstrated proficiency.
* The initial PERJETA dose is 840 mg administered as a 60-minute intravenous infusion, followed every 3 weeks thereafter by 420 mg administered as a 30 to 60 minute intravenous infusion.
* MBC: Administer PERJETA, trastuzumab or trastuzumab hyaluronidase-oysk, and docetaxel every 3 weeks.
* Neoadjuvant: Administer PERJETA, trastuzumab or trastuzumab hyaluronidase-oysk, and chemotherapy preoperatively every 3 weeks for 3 to 6 cycles.
* Adjuvant: Administer PERJETA, trastuzumab or trastuzumab hyaluronidase-oysk, and chemotherapy postoperatively every 3 weeks for a total of 1 year (up to 18 cycles).

biomarker testing

Perjeta clinical details

Genetic testing requirements were obtained from the NCCN guidelines for each cancer type.

drug label

Perjeta prescribing information

Contact Medical Science Liaison Report Adverse Event

prior authorization

Perjeta prior authorization resources

Most recent Perjeta prior authorization forms

View By Payer

Verified: Nov 27, 2023Cigna - Perjeta Prior Authorization Form

Verified: Nov 20, 2023Aetna - Perjeta Prior Authorization Form

Verified: Nov 19, 2023Aetna - Medicare Part B Perjeta Prior Authorization Form

Complete Letter of Medical Necessity

Coverage Authorization Appeals

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Benefits investigation

Combined Prescriber Service Form and Patient Consent Form

Prescriber Service Form - Online Portal

Patient Consent Form - English

Patient Consent Form - Spanish

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Reimbursement help (FRM)

Receive Assistance from an FRM Regarding Reimbursement Information

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pharmacy

Perjeta preferred pharmacy

Pharmacy List

financial assistance

Perjeta financial assistance options

Co-pay savings program

commercial only

Combined Prescriber Service Form and Patient Consent Form

Prescriber Service Form - Online Portal

Patient Consent Form - English

Patient Consent Form - Spanish

Enroll in Patient Savings Program

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Overview

Reduce patient OOP costs for drug (and occasionally for drug administration/infusion costs or drug-related test costs)

Patient benefit

A portion (or all) of patient OOP (deductible, copay), typically up to monthly and/or annual max

Patient eligibility

Patient must enroll or activate (may permit HCPs to enroll on patient’s behalf for HCP-administered drugs)
Generally, must have commercial insurance (rarely, may permit uninsured patients to use)
May never be used with government insurance

How to sign up

Cards may be downloadable digital cards or hard copies
Some pharmacos offer debit cards with pre-loaded copay benefit
Typically, available through multiple channels (e.g., rep to HCP to patient; pharmacy to patient; patient via website, Hub live agent, or copay vendor (live agent or IVR); patient and HCP via Hub enrollment form)
Some HCP-administered product programs permit HCPs to enroll on a patient’s behalf through via Hub form

Foundation programs

under insured

no insurance

goverment insurance

65+

Combined Prescriber Service Form and Patient Consent Form

Prescriber Service Form - Online Portal

Patient Consent Form - English

Patient Consent Form - Spanish

Genentech Patient Foundation Application Form - Prescriber Form

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Overview

Charitable 501(c)(3) organizations provide direct cost-sharing and other support (e.g., travel, counseling) through disease-state funds to indigent patients on first-come first-served basis
These organizations may receive financial contributions from drug manaufacturers for particular disease-state funds that cannot provide funds directly to patients - the foundation must be independent/unaligned

Patient benefit

Patients apply for grants that cover a portion (or all) of their out-of-pocket costs (deductibles and co-pays) until the grant is exhausted

Patient eligibility

Patients must apply and meet eligibility criteria including income level (typically a multiple of federal poverty line), specific diagnosis, insurance status, etc.