PS&R Acthar Gel Commercial Copay Program Terms & Conditions
*Terms and Conditions apply. This benefit covers Acthar® Gel (repository corticotropin injection). The program provides up to $15,000 per calendar year toward the patient's Acthar Gel prescription costs. Eligibility: Available to patients with commercial prescription insurance coverage for Acthar Gel. Co-pay assistance program is not available to patients receiving any form of prescription coverage under any federal, state, or government-funded insurance program or where prohibited by law. Such programs include Medicare (including Medicare Part D and Medicare Advantage), Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs programs. If at any time a patient begins receiving prescription drug coverage under any such federal, state, or government-funded healthcare program, patient will no longer be able to use the Acthar Gel Copay Card and patient must call Acthar Patient Support at 1-888-435-2284 to stop participation. The value of this program is exclusively for the benefit of patients and is intended to be credited towards patient out-of-pocket obligations and maximums, including applicable co payments, coinsurance, and deductibles. Patients are responsible for any out-of-pocket costs above and beyond the program's annual maximum benefit. The offer does not constitute prescription drug coverage and is not intended to substitute health insurance. Patients who are members of insurance plans that adjust their patients' out of pocket co-pay or co-insurance responsibilities for certain prescription drugs based upon the patient's enrollment in manufacturer sponsored co-pay assistance for such drugs (often termed "accumulator" or "maximizer" programs) may be restricted from the Acthar Gel Copay Card program. Patients may not seek reimbursement for value received from the Acthar Gel Copay program from any third-party payers. Restrictions, including monthly maximums, may apply. Other Terms and Conditions apply. Offer subject to change or discontinuance without notice.
PS&R Acthar Gel Commercial Copay Program Terms & Conditions
*Terms and Conditions apply. This benefit covers Acthar® Gel (repository corticotropin injection). The program provides up to $15,000 per calendar year toward the patient's Acthar Gel prescription costs. Eligibility: Available to patients with commercial prescription insurance coverage for Acthar Gel. Co-pay assistance program is not available to patients receiving any form of prescription coverage under any federal, state, or government-funded insurance program or where prohibited by law. Such programs include Medicare (including Medicare Part D and Medicare Advantage), Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs programs. If at any time a patient begins receiving prescription drug coverage under any such federal, state, or government-funded healthcare program, patient will no longer be able to use the Acthar Gel Copay Card and patient must call Acthar Patient Support at 1-888-435-2284 to stop participation. The value of this program is exclusively for the benefit of patients and is intended to be credited towards patient out-of-pocket obligations and maximums, including applicable co payments, coinsurance, and deductibles. Patients are responsible for any out-of-pocket costs above and beyond the program's annual maximum benefit. The offer does not constitute prescription drug coverage and is not intended to substitute health insurance. Patients who are members of insurance plans that adjust their patients' out of pocket co-pay or co-insurance responsibilities for certain prescription drugs based upon the patient's enrollment in manufacturer sponsored co-pay assistance for such drugs (often termed "accumulator" or "maximizer" programs) may be restricted from the Acthar Gel Copay Card program. Patients may not seek reimbursement for value received from the Acthar Gel Copay program from any third-party payers. Restrictions, including monthly maximums, may apply. Other Terms and Conditions apply. Offer subject to change or discontinuance without notice.
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