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Financial Assistance

Gonal-f® Co-Pay Savings Card

Gonal-f® Cares about saving patients money.

For eligible privately insured patients, Gonal-f® Cares can help save up to $200* on out-of-pocket costs with the Gonal-f® Co-Pay Savings Card.

Gonal-f Co-Pay Savings Card

To help your patients save up to $200* per prescription every 21 days:

  • Prescribe any Gonal-f® product
  • Ensure that the patient has the Gonal-f® $200 Co-Pay Savings Card
    • OR Fax card with Rx to pharmacy
    • OR Enter the BIN, GROUP, and ID Numbers into ePrescribe

Request a Gonal-f Co-Pay Card Now

Note: To request materials, you must sign in or register for access.

*Program Details

  • Patients must have a prescription drug benefit that covers Gonal-f® and a valid Gonal-f® prescription
  • Patients cannot combine this card with any other rebate, coupon, free trial, or similar offer
  • Save up to $200 per prescription every 21 days
  • Patient should keep card for repeated use
  • Program expires December 31, 2011, unless earlier terminated by EMD Serono
  • EMD Serono reserves the right to rescind, revoke, terminate, or amend
    the Gonal-f® Co-Pay Savings Card at any time without notice
  • Covers the following products:
    • Gonal-f® RFF Pen 300 IU (follitropin alfa injection)
    • Gonal-f® RFF Pen 450 IU (follitropin alfa injection)
    • Gonal-f® RFF Pen 900 IU (follitropin alfa injection)
    • Gonal-f® Multi-Dose 450 IU (follitropin alfa for injection)
    • Gonal-f® Multi-Dose 1050 IU (follitropin alfa for injection)
    • Gonal-f® RFF 75 IU, single vial pack (follitropin alfa for injection)
    • Gonal-f® RFF 75 IU, 10 vial pack (follitropin alfa for injection)
  • Not valid for cash paying patients
  • Offer not valid for prescriptions that may be reimbursed under federal or state healthcare programs, including Medicaid, Medicare, or any other similar programs, including any state medical pharmaceutical assistance program
  • Void in Massachusetts and other states where rebates are prohibited by law, taxed, or otherwise restricted
Request Materials

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Indication:
For women, Gonal-f® (follitropin alfa for injection), Gonal-f® RFF (follitropin alfa injection) and Gonal-f® RFF Pen (follitropin alfa injection) are indicated for 1) the induction of ovulation and pregnancy in the anovulatory infertile patient in whom the cause of infertility is functional and not due to primary ovarian failure and 2) for the development of multiple follicles in the ovulatory patient participating in an ART program.

Gonal-f® is also indicated for the induction of spermatogenesis in men with primary and secondary hypogonadotropic hypogonadism in whom the cause of infertility is not due to primary testicular failure.

Important Safety Information:
These products should only be prescribed by physicians specializing in fertility or reproductive health. Use of Gonal-f® or Gonal-f® RFF by women can result in multiple births.

Gonal-f® and Gonal-f® RFF are potent gonadotropins capable of causing mild to severe adverse reactions, including Ovarian Hyperstimulation Syndrome (OHSS) in women with or without pulmonary complications. Gonal-f® and Gonal-f® RFF are contraindicated in women and men who exhibit prior hypersensitivity to recombinant FSH preparations or one of their excipients, high levels of FSH indicating primary gonadal failure, uncontrolled thyroid or adrenal dysfunction, sex hormone dependent tumors of the reproductive tract and accessory organs, and an organic intracranial lesion such as a pituitary tumor. Additionally, Gonal-f® and Gonal-f® RFF should not be given to women with abnormal bleeding, presence or enlargement of an ovarian cyst of undetermined origin, or who are pregnant or nursing.

The most common side effects reported in women using Gonal-f® and Gonal-f® RFF include headache, abdominal pain, enlarged abdomen, ovarian cysts, nausea, and upper respiratory infections. Men using Gonal-f® have commonly reported acne, breast pain and growth, fatigue. Injection site reactions have been reported.

Please see accompanying prescribing information below for full disclosure.


RFF: Revised Formulation Female

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This site contains information that is intended for US residents only. Canadian residents should consult the EMD Serono Canada Inc. Web site at www.emdserono.ca for information on products and services approved in Canada.

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