ACTEMRA

OR
For RA Patients Only
If You’re Eligible,
You’ll Pay 0 QR
IV Infusion
SC Injection
No Worries
Any More
We’ll Take
Care of You
ACTEMRA
®
Co-Payment Program
in Qatar
Use your
National
Health Card

Step by Step
Guide for
Rheumatoid Arthritis
Patients in Qatar
ACTEMRA
®
Co-Payment Program in Qatar
Indications:
Rheumatoid Arthritis (RA) [both IV/SC]
Actemra is indicated to reduce signs and symptoms in adult patients with
moderate to severe active rheumatoid arthritis who have failed to respond
adequately to treatment with disease-modifying antirheumatic drugs
(DMARDs) or tumour necrosis factor (TNF) inhibitors. Combination therapy
with methotrexate (MTX) has been shown to slow progression of structural
damage and improve physical function. Actemra may be used alone or in
combination with methotrexate and/or other standard DMARDs.
Polyarticular juvenile idiopathic arthritis (PJIA) [IV only]
Actemra in combination with methotrexate (MTX) is indicated for the
treatment of active polyarticular juvenile idiopathic arthritis in patients 2
years of age and older who have shown an inadequate response to MTX.
Actemra can be given as monotherapy in case of intolerance to MTX.
Systemic juvenile idiopathic arthritis (SJIA) [IV only]
Treatment of children and adolescents aged 2 years and above with
systemic juvenile idiopathic arthritis who have failed to respond adequately
to prior therapy with nonsteroidal anti-inflammatory drugs and steroids
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Get Co-pay Help
When You Need It Most
How can this program help you with your co-Pays?
After the clinical decision to prescribe ACTEMRA is made, the next
step is helping patients access their medicine.
ACTEMRA Co-Payment Program helps eligible patients with the
out-of-pocket (OOP) costs associated with ACTEMRA.
It fully covers monthly co-pays for ACTEMRA (20% of drug cost)
Do you qualify or not?
.
.
Patients may be eligible for the program if the following statements are true:
Rheumatoid Arthritis patients who are/will be treated with Actemra
in approved/registered indications.
Non Qataris who have a residency permit in Qatar, holding the
national health card and receiving their treatment in Hamad
Medical Corporation “HMC“.
. Patients who submitted the necessary documents to QRCS to prove
their financial hardship.
What else should you know about the program?
.
.
.
There is no income limits
You’ll be enrolled if you’re just starting ACTEMRA or if you’re
already on ACTEMRA
The Program is applied on ACTEMRA IV or SC. For ACTEMRA SC,
the program is applied whether administered at the hospital or
self-injection
You’ll be enrolled whether you’re treated in HGH, or Al-Khor
Hospital or Al-Wakra Hospital.

Patient Pathway Through
The Program
At The Program Admin,
The Patient Will:
Collect The Program Guide
. Sign the Consent Form
Program Guide
Consent
Form.
Patient
Flayer
Patient
House/Office
Step 4
The Patient Prepares The
Following Documents:
1. Medical Certificate
2. Passport Copies (+ his family)
3. ID Copy
4. Health Card Copy
5. House Rent Contract (if applicable)
6. Salary Certificate
7. Signed Consent Form
Step 3 Step 5
Hospital
HGH/Al-Khor/Al-Wakra
Return The 7 Documents
To The Program Admin
Step 1
Rheumatology
Dpt.
Program Admin Pharmacy Injection Room
Step 8
Patient Goes With
The HC To Get
ACTEMRA
RA Patient
Step 7
Step 2
+
Step 6
Inform The
Patient – Fund
Approval
ACT IV/SC
Medical
Certificate
Qatar Red Crescent

How To Get Enrolled?
START Enrollment to the Program:
1. After the clinical decision to prescribe ACTEMRA is made, treating
physician will provide you with both the prescription and the
medical certificate including your diagnosis.
2. The program admin at the hospital will educate you about required
documents for enrollment into the program.
3. You will receive the program guidance and a consent form . You’ll
need to sign this consent form and leave it to the admin.
4. Prepare the required documents together with the signed consent
form, then drop it back to the program admin at the hospital.
5. Once eligibility is confirmed, QRCS will inform you immediately that
you can collect ACTEMRA from HMC pharmacy using your Health
Card for payment.
6. The program will cover 3-months co-payment for ACTEMRA at a
time. You’ll be able to receive ACTEMRA on monthly basis.
Please complete all details in the consent form, sign it then leave it back to the
program admin.
RENEW Your Coverage Through The Program:
1. Treating physician will renew prescription of ACTEMRA and update
the medical certificate.
2. Provide your medical certificate to the program admin. No need to
submit new documents.
3. QRCS will call you once fund is settled. Then you can continue
treatment with ACTEMRA using your health card.

What Are The Required
Documents That I Should
Prepare:
You can submit them directly to QRCS office or
through the courier service.
1. Medical Certificate
2. Passport Copies (you + your family)
3. Copy of ID
4. Copy of Health Card
5. Salary Certificate
6. House Rent Contract (if applicable)
7. Signed consent form
You might be ineligible if:
1. You are not resident in Qatar
2. Your financial hardship status is not confirmed by QRCS.
3. You don’t provide ALL required documents for enrollment.
4. You don’t sign the program consent form.
5. You’ll receive your treatment in hospitals other than HGH, Al-Wakra
or Al-Khor (ex. in a private hospital)
You’ll be dropped from the program if:
1. You don’t use the settled fund for ACTEMRA for 3 consecutiv months.
2. You stopped treatment with ACTEMRA or shifted to another drug.

4402 7777
www.qrcs.org.qa
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