Patient Information
Instructions For Use
Full US Prescribing Information

For more information call 1-800-ORENCIA or Sign up Sign up Learn about ORENCIA. Visit ORENCIA.com

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1-800-ORENCIA

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About RA
- About Biologics
About ORENCIA
Could ORENCIA Help?
- What ORENCIA Could Do
- ORENCIA Clinical Results
Starting on ORENCIA
Support and Financial Help
- Services for Self-Injection
- Services for Infusion
ORENCIA and Juvenile
Idiopathic Arthritis
For children 6 years and older with moderate to severe polyarticular JIA.

www.orencia.com

Questions?
Don't want to fill out another form?

Just call 1-800-ORENCIA
and a Care Counselor will be happy to assist you!

We take your privacy seriously. For more information, read our Privacy Policy.

427US11WA24506 Feb/12

Surrounding You with Support

If you are about to start taking ORENCIA^® (abatacept), or are currently on ORENCIA, it's important that you have support and encouragement to help you whenever you need it. That's why we created THE CIRCLE^®, our patient support program. When you register in THE CIRCLE^® you will be assigned a personal ORENCIA Care Counselor—someone to talk to, to help, and to be there when you have questions about ORENCIA.

THE CIRCLE^® Patient Support Services

A support program designed to help ORENCIA patients, including a personal ORENCIA Care Counselor.

THE CIRCLE^® for Patients
on ORENCIA Intravenous Infusion

THE CIRCLE^® for Patients
on ORENCIA Self-Injection

ORENCIA Copay Assistance Program

A financial program to help eligible ORENCIA patients with out-of-pocket drug costs.

Copay Assistance for Patients
on ORENCIA Intravenous Infusion

Copay Assistance for Patients
on ORENCIA Self-Injection

Restrictions and exclusions may apply. BMS reserves the right to revise, revoke or terminate these programs at any time.

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Learn more ORENCIA Intravenous (IV) Infusion and Juvenile Idiopathic Arthritis (JIA)

For children 6 years and older with moderate to severe polyarticular JIA.

A program with a real commitment:

Personalized Information
24/7 ORENCIA Care Counselors
Copay Assistance Program*
Money-Back Offer*

GET STARTED NOW

*Terms and Conditions apply

Hear from Real Patients
How to take ORENCIA
Patient Support Services
Copay Assistance Program

Support Materials

RA Symptom Tracker
This tool helps your doctor understand how rheumatoid arthritis is affecting you over time. Fill it out over the next few weeks and bring it with you to your next doctor's appointment.
Quick RA Checklist
This tool gives your doctor a quick snapshot of your rheumatoid arthritis symptoms. Complete it right before your next appointment and bring it with you.
Personalized Information Kit
Sign up to receive information designed around your personal rheumatoid arthritis challenges.

Real Support
from Real People

Questions about Copay?

Call 1-800-ORENCIA to talk
to a live ORENCIA Care
Counselor located
here in the
United States.

Join THE CIRCLE^® Join THE CIRCLE^® Join THE CIRCLE^® Join THE CIRCLE^® Join THE CIRCLE^®

Want more information on ORENCIA?

Learn about ORENCIA

Learn how ORENCIA is taken

Hear what real patients have to say about ORENCIAYour results may vary.

Fill out the form below so we can send a Personalized Information Kit designed just for you.

Your Personalized Information Kit contains helpful tools and information about ORENCIA^® (abatacept), such as:

How ORENCIA works
How ORENCIA is taken
Information about patient support, such as ORENCIA Care Counselors and the Copay Assistance Program

Fill out the form below so we can send an Information Kit to you.

Your Information Kit contains helpful tools and information about ORENCIA^® (abatacept) for patients with JIA.

How ORENCIA works
How ORENCIA is taken
Information about patient support, such as ORENCIA Care Counselors and the Copay Assistance Program

To receive your Sharps Disposal Kit, please fill out the form below.

By signing up for this free service, you will receive a sharps container to dispose of your syringes after your weekly ORENCIA^® (abatacept) self-injection. The container comes with a prepaid postage package. Just follow the instructions so you can return your used sharps container when it's full and receive a new one. It's one less hassle to deal with.

Note: Limit of 2 containers per year. Other Terms and Conditions apply.

To sign up for the ORENCIA^® (abatacept) Copay Assistance Program for Infusion patients, please fill out the form below.

This program may help reduce your out-of-pocket drug costs to
$5 per infusion, if you are eligible to participate.

See full Terms and Conditions.

To sign up for the ORENCIA^® (abatacept) Copay Assistance Program for Self-Injection patients, please fill out the form below.

This program may help reduce your out-of-pocket drug costs to
$5 per one month's supply, if you are eligible to participate.

See full Terms and Conditions.

To join THE CIRCLE^®, our patient support program, please fill out the form below.

When you register for THE CIRCLE^® you will be assigned a personal ORENCIA^® (abatacept) Care Counselor who provides support whenever you need it. They can also help connect you with a variety of services, as well as Copay Assistance Programs, if you are eligible.

To receive your ORENCIA^® (abatacept) Starter Pack, please fill out the form below.

The Starter Pack provides helpful tools and information for self-injection therapy, including step-by-step injection instructions, and help with insurance questions.

Note: Limit one per patient.

To receive your Travel Cold Case, please fill out the form below.

It's not only convenient, it's easy to use—and comes with the On-the-Go Guide for step-by-step instructions to help keep your medication cool while traveling.

Note: Limit of one per patient.

Thank you for signing up!

You will receive your material shortly.
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Have questions?
Call 1-800-ORENCIA

About You

There were problems with your form. Please review your entries below.

I am a:

Patient Caregiver

If you are a Caregiver, please complete all questions on behalf of the patient.

Have you been diagnosed with Moderate to Severe Rheumatoid Arthritis (RA)?

Yes No

You have selected that you have not been diagnosed with moderate to severe RA.

We are sorry but this program is only available for adult patients that have been diagnosed with moderate to severe rheumatoid arthritis.

Have you, or a child in your care, been diagnosed with Moderate to Severe Polyarticular Juvenile Idiopathic Arthritis (JIA)?

Yes No

You have selected that you have not been diagnosed with moderate to severe JIA.

We are sorry but this information is only available for patients that have been diagnosed with moderate to severe polyarticular juvenile idiopathic arthritis.

I am:

About to start ORENCIA^® (abatacept)
Already on ORENCIA^® (abatacept)
On another treatment for RA

You have selected that you are taking a treatment other than ORENCIA.

ORENCIA starter packs, travel cold cases, and sharps disposable containers are available only to patients taking ORENCIA. However, we still want to send you some helpful information about ORENCIA. Please complete the rest of the form so we can get your kit out to you right away.

THE CIRCLE^® is only available for patients about to start or currently on ORENCIA. However, we still want to send you some helpful information about ORENCIA. Please complete the rest of the form so we can get your kit out to you right away.

I am/They are:

About to start ORENCIA^® (abatacept)
Already on ORENCIA^® (abatacept)
On another treatment for JIA

You have selected that you are taking a treatment other than ORENCIA for JIA.

ORENCIA starter packs, travel cold cases, and sharps disposable containers are available only to patients taking ORENCIA. However, we still want to send you some helpful personalized information about ORENCIA.

Name:

Address:

We'll send you a free, personalized information kit to this address.

Phone:

- -

E-mail:

Your Date of Birth:

You must be 18 years of age or older to register.

Gender:

Female Male

Do you prefer to receive information in Spanish, where available?

Yes No

We take your privacy seriously. For more, read our Privacy Policy.

Continue

About Your RA Treatment

How will you take ORENCIA? Read more

Your doctor will tell you how much ORENCIA to use and when to use it.

A self-injection is an injection given under your skin that you may be able to do yourself, after you are trained by your healthcare professional.

An intravenous (IV) infusion is given through a vein in your arm by a healthcare professional, usually at your doctor's office.

How are you taking ORENCIA? Read more

Your doctor will tell you how much ORENCIA to use and when to use it.

A self-injection is an injection given under your skin that you may be able to do yourself, after you are trained by your healthcare professional.

An intravenous (IV) infusion is given through a vein in your arm by a healthcare professional, usually at your doctor's office.

Self-Injection Infusion (IV)

When will you start taking ORENCIA?

When did you start taking ORENCIA?

How are you taking your rheumatoid arthritis medications? Select all that apply.

Injection
Infusion (IV)
Oral (Pill)

Are you on any of the following rheumatoid arthritis medications?

methotrexate

Actemra^® (tocilizumab)

Arava^® (leflunomide)

Azulfidine^® (sulfasalazine)

Cimzia^® (certolizumab pegol)

Enbrel^® (etanercept)

Humira^® (adalimumab)

Kineret^® (anakinra)

Plaquenil^® (hydroxychloroquine)

Remicade^® (infliximab)

Contact Us
Legal Notice
Privacy Policy
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^© 2012 Bristol-Myers Squibb. All Rights reserved.
ORENCIA, THE CIRCLE, "Oh, Yes I Can!", and theSource for ORENCIA reimbursement needs are registered trademarks, and THE ORENCIA^® (abatacept) COPAY PROGRAM™, and eSource for ORENCIA^® (abatacept) are trademarks of Bristol-Myers Squibb. All other trademarks are the property of their respective owners.

427US11WA24504 Feb/12

Indications and Important Safety Information for ORENCIA® (abatacept)

For children 6 years and older with moderate to severe polyarticular JIA.

Surrounding You with Support

A program with a real commitment:

Fill out the form below so we can send a Personalized Information Kit designed just for you.

Fill out the form below so we can send an Information Kit to you.

To receive your Sharps Disposal Kit, please fill out the form below.

To sign up for the ORENCIA® (abatacept) Copay Assistance Program for Infusion patients, please fill out the form below.

To sign up for the ORENCIA® (abatacept) Copay Assistance Program for Self-Injection patients, please fill out the form below.

To join THE CIRCLE®, our patient support program, please fill out the form below.

To receive your ORENCIA® (abatacept) Starter Pack, please fill out the form below.

To receive your Travel Cold Case, please fill out the form below.

Thank you for signing up!

About You

About You

About Your RA Treatment

Indications and Important Safety Information for ORENCIA^® (abatacept)

To sign up for the ORENCIA^® (abatacept) Copay Assistance Program for Infusion patients, please fill out the form below.

To sign up for the ORENCIA^® (abatacept) Copay Assistance Program for Self-Injection patients, please fill out the form below.

To join THE CIRCLE^®, our patient support program, please fill out the form below.

To receive your ORENCIA^® (abatacept) Starter Pack, please fill out the form below.