Eligibility Restrictions, Terms, and Conditions
TO THE PATIENT:
The Momentum Savings Card is not valid for patients covered under Medicaid, a Medicare Part D
or Medicare Advantage plan, Medigap, TRICARE, CHAMPUS, Puerto Rico Government Health Insurance, or any other state or federal pharmaceutical benefit program or pharmaceutical assistance program and where prohibited by law.
- Card activation is required. See sticker on card face for instructions.
- Patient is responsible for the first $20, plus any differential over $70 for each individual prescription.
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.