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YOUR ELIGIBLE PATIENTS CAN SAVE ON THEIR …

YOUR ELIGIBLE PATIENTS CAN SAVE* ON. THEIR PRESCRIPTIONS FOR BRILINTA. commercially MEDICARE PART D AND CASH-PAYING PATIENTS . insured PATIENTS MEDICAID PATIENTS . PAY AS LOW AS EACH MONTH ONE MONTH FREE*. (up to 60 tablets). ELIGIBLE PATIENTS will pay as ELIGIBLE PATIENTS will receive ELIGIBLE PATIENTS will receive up to low as $5 for a 30-day supply, one 30-day supply of BRILINTA $100 off each 30-day supply subject to a maximum savings (up to 60 tablets) FREE*. of $200 per 30-day supply*. BIN# 004682 GRP# EC57006512 BIN# 004682 GRP# EV57006515 BIN# 004682 GRP# EC57006514. PCN# CN ID# 415092411478 PCN# CN ID# 415095611506 PCN# CN ID# 415095611495. Pharmacist Instructions for a Patient with an ELIGIBLE Submit this claim to CHANGE HEALTHCARE.

COMMERCIALLY INSURED PATIENTS EACH MONTH ONE MONTH FREE* (up to 60 tablets) MEDICARE PART D AND MEDICAID PATIENTS CASH-PAYING PATIENTS Pharmacist Instructions for a Patient with an Eligible Third Party: For Commercially Insured/Covered Patients: Submit the claim to the primary Third-Party Payer first, then submit the balance due …

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Mail Order Rebate Form - BRILINTA

www.brilinta.com

HOW TO RECEIVE THE REBATE FOR MAIL-ORDER PRESCRIPTIONS FOR YOUR BRILINTA 60-MG OR 90-MG TABLETS FOLLOW THESE SIMPLE STEPS Please read the Medication Guide and full Prescribing Information, including Boxed WARNINGS for BRILINTA 60-mg and 90-mg tablets, at www.BRILINTAPI.com

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START SAVING TODAY PAY AS LOW AS 0 BYDUREON BCise …

www.bydureonhcp.com

ELIGIBLE COMMERCIALLY INSURED PATIENTS PAY AS LOW AS EVERY MONTH* $0 WITH YOUR PRESCRIPTION FOR BYDUREON BCise ELIGIBILITY: You may be eligible for this offer if you are insured by commercial insurance and your insurance does not cover the full cost of your prescription, or you are not insured and are responsible for the cost of your prescriptions.

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Boehringer Ingelheim Pharmaceuticals, Inc. Savings Card …

docs.boehringer-ingelheim.com

To the patient: Eligible commercially insured patients 18 years orolder may pay as little as $10/month with a maximum savings up to $175 per 30-day supply. Benefits not to exceed program expiration on December 31, 2022. In Massachusetts and California, the validity of this voucher and its use are subject to state law. Other

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Step-by-step guide to Wegovy Coverage and Savings

www.novomedlink.com

For eligible commercially insured patients currently using another Wegovy™ co-pay card offer, if such patients are prescribed a dose de-escalation within 21 days after the date of fill for the original dose. Maximum benefit of an additional $25 off the patient’s existing

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Access and Reimbursement Guide - vabysmo-hcp.com

www.vabysmo-hcp.com

Help for eligible commercially and publicly insured patients If eligible commercially or publicly insured patients have difficulty paying their co-pay, co-insurance or other out-of-pocket costs, Genentech Ophthalmology Access Solutions can refer them to an independent co-pay assistance foundation ‡ supporting their diagnosis.

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Who may be eligible for Patient Assistance Connection?

www.sanofipatientconnection.com

• If you are enrolled in Medicare Part D, you may also be eligible based on the income criteria noted above. • You must have no insurance coverage or, for commercially insured patients, have no access to the prescribed product or treatment via your insurance.

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Pharmacy Consignment Partnerships

walgreens.csod.com

• Commercially insured patients are eligible for the program. Patients with a high deductible may receive a higher co-pay due to coverage limitations. • Government funded patients are not eligible for the program, however select Medicaid patients may be able to receive assistance from the manufacturer through the Kaleo Cares program.

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35 125 - Almirall Advantage

almiralladvantage.com

Pharmacist instructions for eligible patients who have elected to use Almirall Advantage on a cash-pay basis: You must process the claim in compliance with Almirall Advantage program rules. RESTRICTIONS: Valid only in the United States for commercially insured patients. Cash discounts, cash equivalents, or cash

  Eligible, Insured, Commercially, Commercially insured

DISASTER ASSISTANCE - Farm Service Agency

www.fsa.usda.gov

Eligible Crops Eligible crops must be commercially produced agricultural commodities for which crop insurance is not available and be any of the following: • Crops grown for food; • Crops planted and grown for livestock consumption, such as grain and forage crops, including native forage; Crops grown for

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Your Benefits - Capital One

www.capitalone.ca

Insured Person means a Cardholder and, where specified, certain other eligible persons as outlined under the applicable coverage. Mysterious Disappearance means an article of personal property cannot be located and the circumstances of its disappearance cannot be explained or do not lend themselves to a reasonable inference that a theft occurred.

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