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Sign Up for Support with IMBRUVICA® By Your Side

Sign up for the IMBRUVICA® By Your Side patient support program and begin receiving helpful information and resources about treatment with IMBRUVICA®. With Patient Education and Cost and Coverage support available, IMBRUVICA® By Your Side has something for everyone.

Sign Up for Support with
IMBRUVICA® By Your Side

Sign up for the IMBRUVICA® By Your Side patient support program and begin receiving helpful information and resources about treatment with IMBRUVICA®. With Patient Education and Cost and Coverage support available, IMBRUVICA® By Your Side has something for everyone.

  • Home
  • Patient Support Enrollment

Fill out this short form to begin receiving IMBRUVICA® By Your Side email communications and a welcome phone call from an IMBRUVICA® By Your Side Ambassador.

If you prefer, you can also sign up by calling 1-888-YourSide (1-888-968-7743).

Sign up here


It’s time to get started with IMBRUVICA® By Your Side patient support.

To take advantage of IMBRUVICA® By Your Side patient support, begin by filling out and submitting the information below to sign up.

Once you've signed up, here’s what you can expect from day one:

  • You will begin receiving IMBRUVICA® By Your Side email communications.
  • You will receive a welcome call from an IMBRUVICA® By Your Side Ambassador that provides one-on-one support to help you stay on track with your prescribed treatment plan.
  • If eligible, an IMBRUVICA® Copay Card will be emailed to you following the completion of this form.

Terms and Conditions Apply: The IMBRUVICA® Copay Card applies to commercial insurance copay, deductible, and coinsurance medication costs for IMBRUVICA®. This program cannot be used with any state or other federally-funded prescription insurance program including, but not limited to Medicare Part D, Medicare Advantage Plan, Medicaid, Medigap, VA or DOD or TRICARE, or any other pharmaceutical assistance programs, or where prohibited by law.

Success! Welcome to the IMBRUVICA® By Your Side Support Program

Here’s what you can expect next.

  • You’ll get a phone call from your own, dedicated IMBRUVICA® By Your Side Ambassador. This call may come from a number you don’t recognize.
  • You’ll also start receiving email communications from the IMBRUVICA® By Your Side support program. Keep an eye on your inbox for your first email, coming soon!

Keep an eye on your inbox for your first email, coming soon!

Here’s what you can expect next.

  • You’ll get a phone call from your own, dedicated IMBRUVICA® By Your Side Ambassador. This call may come from a number you don’t recognize.
  • You’ll also start receiving email communications from the IMBRUVICA® By Your Side support program. Keep an eye on your inbox for your first email, coming soon!

Keep an eye on your inbox for your first email, coming soon!

You’ve successfully enrolled in the IMBRUVICA® By Your Side patient support program, but your IMBRUVICA® Copay Card application has been rejected. If you feel like this is an error, please call 1-888-YourSide (1-888-968-7743).

 

Here’s what you can expect next.

  • You’ll get a phone call from your own, dedicated IMBRUVICA® By Your Side Ambassador. This call may come from a number you don’t recognize.
  • You’ll also start receiving email communications from the IMBRUVICA® By Your Side support program.

Keep an eye on your inbox for your first email, coming soon!

You can also begin to use the IMBRUVICA® Copay Card immediately.

Your official copay card has been sent to you based on your preferred method of communication. In the meantime, you can download this page and present it along with a valid prescription for IMBRUVICA® to your pharmacist for an instant savaings that can be applied toward out-of-pocket expenses on you prescription for IMBRUVICA®.

Copay Program

RxBIN: 610524 RxGRP: IMB57962 RxPCN: Loyalty ISSUER: 80840 ID: XXXXXXXXXX
Eligible Patients Pay as Little as $10

Eligible patients may pay as little as $10 per prescription of IMBRUVICA® until the maximum limit of $24,600 per calendar year is reached. The IMBRUVICA® Copay Program applies to commercial insurance copay, deductible, and coinsurance medication costs for IMBRUVICA®. This program cannot be used with any state or other federally-funded prescription insurance program including, but not limited to Medicare Part D, Medicare Advantage Plan, Medicaid, Medigap, VA or DOD or TRICARE, or any other pharmaceutical assistance programs, or where prohibited by law.

Pharmacyclics An AbbVie Company

To the Patient: You must present this card to the pharmacist along with your prescription to participate in this program. If you have any questions regarding your eligibility or benefits, or if you wish to discontinue your participation, call the IMBRUVICA® By Your Side patient support program at 1-888-YourSide (1-888-968-7743), (Monday - Friday, 8:00 AM - 8:00 PM and Saturday, 8:00 AM - 5:00 PM ET). When you use this card, you are certifying that you understand the program rules, regulations, and terms and conditions. You are not eligible if prescriptions are paid by any state or other federally funded programs, including, but not limited to Medicare Part D, Medicare Advantage Plan, or Medicaid, Medigap, VA or DOD or TRICARE, or where prohibited by law; and you will otherwise comply with the terms above.

To the Pharmacist: When you use this card, you are certifying that you have not submitted and will not submit a claim for reimbursement under any federal, state or other governmental programs for this prescription.

  • Submit transaction to RxC Acquisition Company d/b/a RxCrossroads by McKesson using BIN #610524
  • If primary commercial prescription insurance exists, input card information as secondary coverage and transmit using the COB segment of the NCPDP transaction. Applicable discounts will be displayed in the transaction response
  • Acceptance of this card and your submission of claims for the IMBRUVICA® Copay Program program are subject to the LoyaltyScript® program Terms and Conditions posted at www.mckesson.com/mprstnc
  • Patient is not eligible if prescriptions are paid in part or full by any state or federally-funded programs, including but not limited to Medicare Part D, Medicare Advantage Plan, or Medicaid, Medigap, VA, DOD or TRICARE and where prohibited by law
  • The LoyaltyScript® card is not valid for use with any other prescription drug discount or cash cards for IMBRUVICA®. Claims submitted utilizing the program are subject to audit or validation
  • For questions regarding setup, claim transmission, patient eligibility or other issues, call the LoyaltyScript® for IMBRUVICA® program at 1-855-332-6211  (Monday - Friday, 8:00 AM - 8:00 PM ET, excluding holidays)

Pharmacyclics LLC, an AbbVie Company, reserves the right to rescind, revoke or amend this offer at any time.

RxBIN: 610524 RxGRP: IMB57962 RxPCN: Loyalty ISSUER: 80840 ID: XXXXXXXXXX

To the Patient: You must present this card to the pharmacist along with your prescription to participate in this program. If you have any questions regarding your eligibility or benefits, or if you wish to discontinue your participation, call the IMBRUVICA® By Your Side patient support program at 1-888-YourSide (1-888-968-7743), (Monday - Friday, 8:00 AM - 8:00 PM and Saturday, 8:00 AM - 5:00 PM ET). When you use this card, you are certifying that you understand the program rules, regulations, and terms and conditions. You are not eligible if prescriptions are paid by any state or other federally funded programs, including, but not limited to Medicare Part D, Medicare Advantage Plan, or Medicaid, Medigap, VA or DOD or TRICARE, or where prohibited by law; and you will otherwise comply with the terms above.

To the Pharmacist: When you use this card, you are certifying that you have not submitted and will not submit a claim for reimbursement under any federal, state or other governmental programs for this prescription.

  • Submit transaction to RxC Acquisition Company d/b/a RxCrossroads by McKesson using BIN #610524
  • If primary commercial prescription insurance exists, input card information as secondary coverage and transmit using the COB segment of the NCPDP transaction. Applicable discounts will be displayed in the transaction response
  • Acceptance of this card and your submission of claims for the IMBRUVICA® Copay Program program are subject to the LoyaltyScript® program Terms and Conditions posted at www.mckesson.com/mprstnc
  • Patient is not eligible if prescriptions are paid in part or full by any state or federally-funded programs, including but not limited to Medicare Part D, Medicare Advantage Plan, or Medicaid, Medigap, VA, DOD or TRICARE and where prohibited by law
  • The LoyaltyScript® card is not valid for use with any other prescription drug discount or cash cards for IMBRUVICA®. Claims submitted utilizing the program are subject to audit or validation
  • For questions regarding setup, claim transmission, patient eligibility or other issues, call the LoyaltyScript® for IMBRUVICA® program at 1-855-332-6211  (Monday - Friday, 8:00 AM - 8:00 PM ET, excluding holidays)

Pharmacyclics LLC, an AbbVie Company, reserves the right to rescind, revoke or amend this offer at any time.

IMPORTANT SIDE EFFECT INFORMATION

Before taking IMBRUVICA®, tell your healthcare provider about all of your medical 
conditions, including if you:

  • have had recent surgery or plan to have surgery. Your healthcare provider may stop IMBRUVICA® for any planned medical, surgical, or dental procedure.
  • have bleeding problems
  • have or had heart rhythm problems, smoke, or have a medical condition that increases your risk of heart disease, such as high blood pressure, high cholesterol, or diabetes
  • have an infection
  • have liver problems
  • are pregnant or plan to become pregnant. IMBRUVICA® can harm your unborn baby. If you are able to become pregnant, your healthcare provider will do a pregnancy test before starting treatment with IMBRUVICA®. Tell your healthcare provider if you are pregnant or think you may be pregnant during treatment with IMBRUVICA®. 
    • Females who are able to become pregnant should use effective birth control (contraception) during treatment with IMBRUVICA® and for 1 month after the last dose.
    • Males with female partners who are able to become pregnant should use effective birth control, such as condoms, during treatment with IMBRUVICA® and for 1 month after the last dose.
  • are breastfeeding or plan to breastfeed.  Do not breastfeed during treatment with IMBRUVICA® and for 1 week after the last dose. 

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Taking IMBRUVICA® with certain other medicines may affect how IMBRUVICA® works and can cause side effects.

How should I take IMBRUVICA®?

  • Take IMBRUVICA® exactly as your healthcare provider tells you to take it.
  • Take IMBRUVICA® 1 time a day.
  • Swallow IMBRUVICA® capsules or tablets whole with a glass of water.
  • Do not open, break or chew IMBRUVICA® capsules.
  • Do not cut, crush or chew IMBRUVICA® tablets.
  • Take IMBRUVICA® at about the same time each day.
  • If you miss a dose of IMBRUVICA® take it as soon as you remember on the same day. Take your next dose of IMBRUVICA® at your regular time on the next day. Do not take extra doses of IMBRUVICA® to make up for a missed dose.
  • If you take too much IMBRUVICA® call your healthcare provider or go to the nearest hospital emergency room right away. 

What should I avoid while taking IMBRUVICA®?

  • You should not drink grapefruit juice, eat grapefruit, or eat Seville oranges (often used in marmalades) during treatment with IMBRUVICA®. These products may increase the amount of IMBRUVICA® in your blood.

What are the possible side effects of IMBRUVICA®?

IMBRUVICA® may cause serious side effects, including:

  • Bleeding problems (hemorrhage) are common during treatment with IMBRUVICA®, and can also be serious and may lead to death. Your risk of bleeding may increase if you are also taking a blood thinner medicine. Tell your healthcare provider if you have any signs of bleeding, including: blood in your stools or black stools (looks like tar), pink or brown urine, unexpected bleeding, or bleeding that is severe or that you cannot control, vomit blood or vomit looks like coffee grounds, cough up blood or blood clots, increased bruising, dizziness, weakness, confusion, change in your speech, or a headache that lasts a long time or severe headache.  
  • Infections can happen during treatment with IMBRUVICA®. These infections can be serious and may lead to death. Tell your healthcare provider right away if you have fever, chills, weakness, confusion, or other signs or symptoms of an infection during treatment with IMBRUVICA®.
  • Decrease in blood cell counts. Decreased blood counts (white blood cells, platelets, and red blood cells) are common with IMBRUVICA®, but can also be severe.  Your healthcare provider should do monthly blood tests to check your blood counts.
  • Heart problems. Serious heart rhythm problems (ventricular arrhythmias, atrial fibrillation, and atrial flutter), heart failure, and death have happened in people treated with IMBRUVICA®, especially in people who have an increased risk for heart disease, have an infection, or who have had heart rhythm problems in the past. Tell your healthcare provider if you get any symptoms of heart problems, such as feeling as if your heart is beating fast and irregular, lightheadedness, dizziness, shortness of breath, swelling of the feet, ankles, or legs, chest discomfort, or you faint.  If you develop any of these symptoms, your healthcare provider may do a test to check your heart (ECG) and may change your IMBRUVICA® dose.
  • High blood pressure (hypertension). New or worsening high blood pressure has happened in people treated with IMBRUVICA®. Your healthcare provider may start you on blood pressure medicine or change current medicines to treat your blood pressure.
  • Second primary cancers. New cancers have happened during treatment with IMBRUVICA®, including cancers of the skin or other organs.
  • Tumor lysis syndrome (TLS). TLS is caused by the fast breakdown of cancer cells. TLS can cause kidney failure and the need for dialysis treatment, abnormal heart rhythm, seizure, and sometimes death. Your healthcare provider may do blood tests to check you for TLS.

The most common side effects of IMBRUVICA® in adults with B-cell malignancies (MCL, CLL/SLL, WM and MZL) include:

  • diarrhea
  • tiredness
  • muscle and bone pain
  • rash
  • bruising

The most common side effects of IMBRUVICA® in adults with cGVHD include:

  • tiredness
  • bruising
  • diarrhea
  • mouth sores (stomatitis)
  • muscle spasms
  • nausea
  • pneumonia

Diarrhea is a common side effect in people who take IMBRUVICA®. Drink plenty of fluids during treatment with IMBRUVICA® to help reduce your risk of losing too much fluid (dehydration) due to diarrhea. Tell your healthcare provider if you have diarrhea that does not go away.

These are not all the possible side effects of IMBRUVICA®. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

General information about the safe and effective use of IMBRUVICA®

Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use IMBRUVICA® for a condition for which it was not prescribed. Do not give IMBRUVICA® to other people, even if they have the same symptoms that you have. It may harm them. You can ask your pharmacist or healthcare provider for information about IMBRUVICA® that is written for health professionals.

Please see the full Important Product Information.

USES

What is IMBRUVICA® (ibrutinib)?

IMBRUVICA® (ibrutinib) is a prescription medicine used to treat adults with: 

  • Chronic lymphocytic leukemia (CLL)/Small lymphocytic lymphoma (SLL)
  • Chronic lymphocytic leukemia (CLL)/Small lymphocytic lymphoma (SLL) with 17p deletion
  • Waldenström’s macroglobulinemia (WM)
  • Chronic graft versus host disease (cGVHD) after failure of 1 or more lines of systemic therapy

It is not known if IMBRUVICA® is safe and effective in children.

IMPORTANT SIDE EFFECT INFORMATION

USES