Welcome to the STIVARGA® $0 Co-Pay Program

For Health Care Professionals

The zero dollar STIVARGA co-pay program allows patients to fill their prescription with no out-of-pocket costs for eligible, commercially insured patients. Patients can receive up-to $25,000 in saving with no monthly maximum. The 3-step enrollment is simple, with no forms, faxes, or signatures required.

Step 1: Verify Patient Eligibility

The Question 1 selection is required

The Question 2 selection is required

The Question 3 selection is required

The Question 4 selection is required

1.

The patient is a United States Resident.

2.

The patient is over 18 years old.

3.

The patient currently has commercial health insurance for a portion of his/her prescription drug cost.

4.

The patient is NOT enrolled in any federal or state subsidized healthcare program that covers a portion of my prescription drug costs, including Medicare (such as Medicare Part D prescription drug benefit), Medicaid, TRICARE, or any other federal or state healthcare plan, including pharmaceutical assistance programs.

Required field.*

New Patient (Update Information as Needed Before Submitting Enrollment)

The First Name field is required.

The Last Name field is required.

The Date of Birth field is required.

The Preferred Method of Contact field is required.

The Address field is required.

The City field is required.

The State field is required.

The Zip field is required.

The Phone Number field is required.

The Confirm E-mail Address field is required.

Patient Information

Click to complete enrollment.

STIVARGA® $0 CO-PAY PROGRAM TERMS & CONDITIONS

  • Patient must meet the eligibility requirements of the STIVARGA $0 co-pay Program ; for example, only commercially insured patients are eligible
  • Patient eligibility will be reassessed annually
  • Offer is expressly contingent on the requirement that the patient understand, accept, and comply with all requirements of the co-pay program
  • Use of the co-pay program must be consistent with and not prohibited by the requirements of the patient's health insurance
  • Patient agrees not to submit any portion toward the product dispensed pursuant to this co-pay program to a federal or state healthcare program for purposes of counting it toward the patient's out-of-pocket expenses (such as Medicaid)
  • Co-pay assistance is capped at $25,000 per year, per patient
  • Use of $0 co-pay must be for STIVARGA use that is consistent with the FDA-approved indications
  • The program does not cover costs associated with a patient visit including prescriber, staff, or administrative charges associated with administering the applicable Bayer product
  • Offer valid only for patients treated in the USA, including Puerto Rico, Guam and US Territories
  • Bayer reserves the right to determine eligibility, monitor participation, equitably distribute product and modify or discontinue the $0 Co-pay Program at any time with or without notice
  • Patient agrees to provide necessary health information to the administrators of the STIVARGA $0 co-pay program
  • For questions about the co-pay program, call the STIVARGA $0 co-pay program support at 1-866-581-4992

Indications and Important Safety Information

INDICATIONS

STIVARGA (regorafenib) is a prescription medicine used to treat people with:

  • colon or rectal cancer that has spread to other parts of the body and for which they have received previous treatment with certain chemotherapy medicines
  • a rare stomach, bowel, or esophagus cancer called GIST (gastrointestinal stromal tumor) that cannot be treated with surgery or that has spread to other parts of the body and for which they have received previous treatment with certain medicines
  • a type of liver cancer called hepatocellular carcinoma (HCC) in people who have been previously treated with sorafenib

It is not known if STIVARGA is safe and effective in children less than 18 years of age.

IMPORTANT SAFETY INFORMATION

STIVARGA (regorafenib) can cause liver problems, which can be serious and sometimes lead to death. Your healthcare provider will do blood tests to check your liver function before you start taking STIVARGA and during your treatment with STIVARGA to check for liver problems. Tell your healthcare provider right away if you experience yellowing of your skin or the white part of your eyes, nausea, vomiting, dark urine, or change in your sleep pattern.

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

  • have liver problems in addition to liver cancer
  • have bleeding problems
  • have high blood pressure
  • have heart problems or chest pain
  • plan to have surgery or have had a recent surgery. You should stop taking STIVARGA at least 2 weeks before planned surgery
  • are pregnant or plan to become pregnant. STIVARGA can harm your unborn baby. Females and males should use effective birth control during treatment with STIVARGA and for 2 months after their last dose of STIVARGA. Tell your healthcare provider right away if you or your partner becomes pregnant either while taking STIVARGA or within 2 months after your last dose of STIVARGA
  • are breast-feeding or plan to breast-feed. It is not known if STIVARGA passes into your breast milk. Do not breastfeed during treatment with STIVARGA and for 2 weeks after your final dose of STIVARGA.

Tell your healthcare provider about all the prescription and over-the-counter medicines, vitamins, and herbal supplements you take. Avoid drinking grapefruit juice and taking St. John’s Wort while taking STIVARGA.

STIVARGA may cause serious side effects, including:

  • infection. STIVARGA may lead to a higher risk of infections especially of the urinary tract, nose, throat and lung. STIVARGA may lead to a higher risk of fungal infections of the mucous membrane, skin or the body. Tell you healthcare provider right away if you get fever, severe cough with or without an increase in mucus (sputum) production, severe sore throat, shortness of breath, burning or pain when urinating, unusual vaginal discharge or irritation, redness, swelling or pain in any part of the body
  • severe bleeding. STIVARGA can cause bleeding, which can be serious and sometimes lead to death. Tell your healthcare provider if you have any signs of bleeding while taking STIVARGA, including: vomiting blood or if your vomit looks like coffee grounds, pink or brown urine, red or black (looks like tar) stools, coughing up blood or blood clots, menstrual bleeding that is heavier than normal, unusual vaginal bleeding, nose bleeds that happen often, bruising, and lightheadedness
  • a tear in your stomach or intestinal wall (bowel perforation). STIVARGA may cause a tear in your stomach or intestinal wall that can be serious and sometimes lead to death. Contact your healthcare provider immediately if you notice severe pains or swelling in your stomach area (abdomen), fever, chills, nausea, vomiting, or dehydration
  • a skin problem called hand-foot skin reaction and severe skin rash. Hand-foot skin reactions are common and sometimes can be severe. Tell your healthcare provider right away if you get redness, pain, blisters, bleeding, or swelling on the palms of your hands and soles of your feet, or a severe rash
  • high blood pressure. Your blood pressure should be checked every week for the first 6 weeks of starting STIVARGA. Your blood pressure should be checked regularly and any high blood pressure should be treated while you are receiving STIVARGA. Tell your healthcare provider if you have severe headaches, light-headedness, or changes in your vision
  • decreased blood flow to the heart and heart attack. Get emergency help if you have chest pain, have shortness of breath, feel dizzy, or feel like passing out
  • a condition called reversible posterior leukoencephalopathy syndrome (RPLS). Call your healthcare provider right away if you get severe headaches, seizure, confusion, change in vision, or problems thinking
  • risk of wound healing problems. Wounds may not heal properly during STIVARGA treatment. Tell your healthcare provider if you plan to have any surgery before starting or during treatment with STIVARGA.
    • You should stop taking STIVARGA at least 2 weeks before planned surgery.
    • Your healthcare provider should tell you when you may start taking STIVARGA again after surgery.

The most common side effects with STIVARGA include pain including stomach-area (abdomen); tiredness, weakness, fatigue; diarrhea (frequent or loose bowel movements); decreased appetite; infection; voice change or hoarseness; increase in certain liver function tests; fever; swelling, pain, and redness of the lining in your mouth, throat, stomach, and bowel (mucositis); and weight loss

For important risk and use information for STIVARGA, please see the full Prescribing Information
You are encouraged to report negative side effects or quality complaints of prescription drugs to the FDA.
Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

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