Effective as of September 21, 2021.
By using the copay savings card for OPZELURA, you acknowledge that your patient currently meets the eligibility criteria and understands the Terms and Conditions described below:
- The patient is not eligible to use this copay savings card if they are enrolled in a state or federally funded prescription insurance program, including, but not limited to, Medicare, Medicaid, TRICARE, Veteran Affairs health care, a state prescription drug assistance program, or the Government Health Insurance Plan available in Puerto Rico (formerly known as "La Reforma de Salud")
- The patient must have commercial insurance. Offer is not valid for cash-paying patients
- By using this copay savings card at participating pharmacies, eligible patients with commercial prescription drug insurance coverage for OPZELURA may pay as little as $10 per tube. Individual savings are limited to $2,076.50/tube. Individual patient savings are limited to $10,000 in maximum total savings per calendar year
- This copay savings card is not valid when the entire cost of the patient’s prescription drug is eligible to be reimbursed by their commercial insurance plan or any other health or pharmacy benefit program
- Neither the patient, nor the patient's guardian, pharmacist, or doctor may seek any third-party reimbursement for the value of the copay savings received under this offer
- The patient is responsible for reporting use of the copay savings card to any commercial insurer, health plan, or other third party that pays for or reimburses any part of the prescription filled using the copay savings card, as may be required. The patient should not use the copay savings card if their insurer or health plan prohibits use of manufacturer copay cards
- This copay savings card is not valid where prohibited by law
- This copay savings card cannot be combined with any other savings, free trial, or similar offer for the specified prescription
- This copay savings card will be accepted only at participating pharmacies
- This copay savings card is not health insurance
- Offer good only in the U.S. and Puerto Rico
- The copay savings card benefit may not be redeemed more than once per 25 days per patient
- Offer valid only for an FDA-approved use
- No other purchase is necessary
- Data related to your patient’s redemption of the copay savings card may be collected, analyzed, and shared with Incyte or its affiliates for market research and other purposes related to assessing Incyte’s programs. Data shared will be aggregated and de-identified; it will not identify your patient