![]() ![]() Patient is responsible for applicable taxes, if any Eligibility and terms and conditions apply. ![]() The parties reserve the right to rescind, revoke, or amend this offer without notice at any time.Present your activated Co-pay Card to your pharmacist, along with your ELIQUIS prescriptionĮligible patients who present an activated Co-pay Card together with a valid prescription for ELIQUIS at participating pharmacies may pay as little as $10 per 30-day supply (up to 74 tablets for the first fill, and up to 60 tablets for all subsequent fills) for up to 24 months, subject to a maximum annual benefit of $6,400.For commercially insured patients. Program managed by ConnectiveRx on behalf of Xeris Pharmaceuticals, Inc. This offer is not transferable and is limited to 1 offer per person. It is illegal to (or offer to) sell, purchase, or trade this offer. By using this offer, the patient certifies that he or she will comply with any terms of his or her health insurance contract requiring notification to his or her payer of the existence and/or value of this offer. If the patient is eligible for drug benefits under any such program, the patient cannot use this offer. Cash discount cards and other non-insurance plans are not valid as primary under this offer. Offer not valid for prescriptions reimbursed under Medicaid, a Medicare drug benefit plan, Tricare, or other federal or state health programs (such as medical assistance programs). Offer not available for cash paying patients. Restrictions: This offer is valid in the United States and Puerto Rico. For any questions regarding CHANGE HEALTHCARE online processing, please call the Help Desk at 1-80. Reimbursement will be received from CHANGE HEALTHCARE. ![]() ![]() Monthly and annual maximum caps may apply. Submit the claim to the primary third-party payer first, then submit the balance due to CHANGE HEALTHCARE as a secondary payer COB with patient responsibility amount and a valid Other Coverage Code (eg, 8). Pharmacist instructions for a patient with an eligible third party payer By participating in this program, you are certifying that you will comply with the terms and conditions described in the Restrictions section below. Participation in this program must comply with all applicable laws and regulations as a pharmacy provider. Pharmacist:When you apply this offer, you are certifying that you have not submitted a claim for reimbursement under any federal, state, or other governmental programs for this prescription. By using this offer, you are certifying that you meet the eligibility criteria and will comply with the terms and conditions described in the Restrictions section below.įor offer details and patients with questions, please call 1-877-myGvoke. Follow the dosage instructions given by the doctor. Patient instructions: In order to redeem this offer you must have a valid prescription for Gvoke PFS, Gvoke HypoPen, and/or Gvoke Kit. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |