Request a Savings Card
  • 1 Verify
    Eligibility
  • 2 Select
    Preferences
  • 3 Enter Contact
    Details

To help us confirm you are eligible for a Savings Card,
please answer the following question.

Is your prescription paid for in part or in full under any state or federally funded programs, including, but not limited to: Medicaid, Medicare, Medigap, Department of Defense (DoD), Veterans Affairs (VA), TRICARE, or any state patient or pharmaceutical assistance program?

Yes No

We're sorry, but you are not eligible for the Momentum Savings Card. However, you may still enroll in the Momentum Program to receive tips and tools that can help you start strong and stay on track. To enroll, select the "Submit Information" button below.

By clicking the "Submit Information" button below, you certify that the information you provided above is correct and you understand that, should your prescription be paid for in part or in full under any federal, state, or government program, you will no longer be eligible to participate in this program.

Eligibility Restrictions

TO THE PATIENT:

Patients paying cash are not eligible to receive the first prescription at no cost. This offer is for eligible patients who have commercial prescription insurance. The offer is not valid for patients with prescription insurance under any federal or state healthcare program, including, but not limited to, Medicaid, Medicare, Medigap, Department of Defense (DoD), Veterans Affairs (VA), TRICARE, CHAMPUS, Puerto Rico Government Health Insurance, or any State Patient or Pharmaceutical Assistance Program. This offer is void where prohibited by law. Certain rules and restrictions apply. This program is not insurance.

PLEASE NOTE:

If you are not eligible for the Momentum Savings Card, you may still enroll in the program to receive tips, suggestions, helpful advice, recipes and other useful information.

If you need assistance with the Momentum Program, please call 1-855-326-1404. An agent is available to assist you from 8 AM to 8 PM ET, Monday through Friday.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.