enroll in IMBRUVICA® patient support
Welcome to IMBRUVICA® By Your Side, a comprehensive, personalized support experience designed to help IMBRUVICA® patients start and stay on track with the treatment plan you prescribed.
IMBRUVICA® By Your Side provides:
Comprehensive Resources
Dedicated Ambassadors
Financial Guidance
Complete this form with the permission of your patient to enroll them in IMBRUVICA® By Your Side, so they can get the support they need throughout their treatment journey.

Prescriber Information
Patient Details
Insurance Information
Enrollment Complete

Registration complete!
Thank you for enrolling your patient in IMBRUVICA® By Your Side! Make sure to DOWNLOAD and PRINT or EMAIL the IMBRUVICA® By Your Side patient information to give to your patient before leaving your office.
To Request a Benefit Verification: Call: 1-888-YourSide (1-888-968-7743). Choose option 2 for Healthcare Professional. Then select option 1 to speak to an Access Specialist.

What to expect next:
Remind your patient to expect a call from an Ambassador within one business day (call may come from any area code, including a toll free number).
Ambassadors provide important educational resources, answer questions and help navigate the prescription process and identify ways patients may be able to save on IMBRUVICA®.
IMBRUVICA® Copay Card
Your patient has qualified for the copay card.

Eligibility: Available to patients with commercial insurance coverage for IMBRUVICA® (ibrutinib) who meet eligibility criteria. This copay assistance program is not available to patients receiving prescription reimbursement under any federal, state, or government-funded insurance programs (for example, Medicare [including Part D], Medicare Advantage, Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs programs) or where prohibited by law. Offer subject to change or termination without notice. Restrictions, including monthly maximums, may apply. This is not health insurance. For full Terms and Conditions, visit https://www.imbruvica.com/imbruvica-by-your-side or call 1-888-YourSide (1-888-968-7743) for additional information. To learn about Pharmacyclics’ privacy practices and your privacy choices, visit https://www.pharmacyclics.com/privacy-policy

*Eligibility: Available to patients with commercial insurance coverage for IMBRUVICA® (ibrutinib) who meet eligibility criteria.
This copay assistance program is not available to patients receiving prescription reimbursement under any federal, state, or government-funded insurance programs (for example, Medicare [including Part D], Medicare Advantage, Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs programs) or where prohibited by law. Offer subject to change or termination without notice. Restrictions, including monthly maximums, may apply. This is not health insurance. For full Terms and Conditions, visit https://www.imbruvica.com/imbruvica-by-your-side or call 1-888-YourSide (1-888-968-7743) for additional information. To learn about Pharmacyclics’ privacy practices and your privacy choices, visit https://www.pharmacyclics.com/privacy-policy.
IMBRUVICA® Copay Full Terms and Conditions
Terms and Conditions apply. This benefit covers IMBRUVICA® (ibrutinib). Eligibility: Available to patients with commercial insurance coverage for IMBRUVICA® who meet eligibility criteria. Copay assistance program is not available to patients receiving reimbursement under any federal, state, or government-funded insurance programs (for example, Medicare [including Part D], Medicare Advantage, Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs programs) or where prohibited by law or by the patient’s health insurance provider. If at any time a patient begins receiving drug coverage under any such federal, state, or government-funded healthcare program, patient will no longer be able to use the IMBRUVICA® Copay Card and patient must call IMBRUVICA® at 1-855-332-6210 to stop participation. Patients residing in or receiving treatment in certain states may not be eligible. Patients may not seek reimbursement for value received from the IMBRUVICA® Copay Card program from any third-party payers. Offer subject to change or discontinuation without notice. Restrictions, including monthly maximums, may apply. Subject to all other terms and conditions, the maximum annual benefit that may be available solely for the patient’s benefit under the copay assistance program is $24,600 per calendar year. The actual application and use of the benefit available under the copay assistance program may vary on a monthly, quarterly, and/or annual basis depending on each individual patient’s plan of insurance and other prescription drug costs. This assistance offer is not health insurance. By redeeming this card, you acknowledge that you are an eligible patient and that you understand and agree to comply with the terms and conditions of this offer. To learn about Pharmacyclics’ privacy practices and your privacy choices, visit https://www.pharmacyclics.com/privacy-policy.