Copay Program Terms and Conditions

  • Eligibility and enrollment are required
  • For use only with commercial prescription insurance
  • May not be used if the patient is enrolled in a government-funded prescription insurance program
  • Patients with Federal Employees Health Benefits Plan (FEP) or Health Care Exchange Plans (HIX) are eligible for assistance
  • May not be used by patients who pay cash for their prescriptions
  • Individual out-of-pocket costs may vary
  • A maximum benefit per prescription and per calendar year may apply
  • Patients must be 18 years of age or older and a resident of the United States
  • Additional Terms and Conditions apply