Take advantage of the XYOSTED co-pay assistance program!

XYOSTED STEADYCare Support Program provides financial support to eligible commercially insured patients to assist with out-of-pocket costs of XYOSTED. Eligible patients* may pay as low as a $0 co-pay for each prescription filled. This card is valid for up to 13 fills.

While waiting for prior authorization or managed care appeals, the STEADYCare Support Program can help patients get started on XYOSTED with their first prescription free of charge. Additionally the program provides a maximum benefit up to $125 per 28-day supply and up to $375 for a 3 month supply.

In order to be able to better assist you and help you pay as little as possible, we will need your Health Insurance Portability and Accountability Act (HIPAA) authorization. As a reminder, HIPAA is the law that provides data privacy and security to protect your health information. We believe that by taking a little extra time now to provide HIPAA authorization, we can help you pay as little as possible for your XYOSTED medication. You are not obligated to provide HIPAA authorization, however, our ability to assist you will be limited without this authorization.

Not valid for prescriptions reimbursed under any federal or state healthcare program, including Medicare, Medicaid, MediGap or Tricare. This may also include state pharmaceutical assistance programs and other federal or state plans not listed. Those on Medicare Part D, even if in the coverage gap, are not eligible. Please note: You will no longer be eligible if you begin to have coverage from any Government Program.
Void where prohibited by law, taxed, or restricted.

Valid in the US only.

Antares Pharma, Inc. reserves the right to rescind, revoke, or amend this offer at any time without notice.
By using this co-pay card, you demonstrate that you understand and agree to comply with the terms and conditions of this offer as put forth on this co-pay assistance card.

1. Activate your card
2. Present this card with a valid prescription to your pharmacist.
3. You will receive co-pay assistance for up to $125 per 28-day prescription.
4. If you have any questions, please feel free to call 866-255-8984.

You recognize and agree that when submitting your personally identifying information, while Antares has safeguards in place to prevent unauthorized access or interception, there is no absolute guarantee of security. In the unlikely event of an interception or unauthorized access despite our efforts, Antares shall not be responsible for such interceptions or unauthorized access, or any direct, indirect, special, incidental, or consequential damages (including lost profits) suffered by a user, even if Antares has previously been advised of the possibility of such damages, Antares does not warrant, either expressly or implied, that the information provided by any customer shall be free from interception or unauthorized access, and does not provide any implied warranties of merchantability and fitness for a particular purpose.

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. For more information, go to www.XYOSTED.com or call 1-844-XYOSTED (1-844-996-7833).