Program Rules: Patient Eligibility, Terms, and Conditions
to Medicare or Medicaid, Medigap, VA, DOD, or TRICARE® and where prohibited by law. The free trial and copay prescriptions shall not be submitted
for reimbursement to any private or public third-party payer, including Medicaid or Medicare, or any other similar federal or state healthcare program.
Offer is valid in the USA.
Lundbeck reserves the right to rescind, revoke, or amend this offer without notice. When you use ONFI Savings, you are certifying that you understand
the program rules, regulations, and terms and conditions. Savings cannot be combined with any other rebate, coupon, free trial, or similar offer.
Patients with no insurance or no coverage may qualify for ONFI (clobazam) CIV at no cost. Call the ONFI Support Center at 1-855-345-6634 for
details. By using the Savings, patients agree to the terms and conditions of this program.
Using mail-order pharmacies
Check with your mail-order pharmacy to see if they accept loyalty cards such as the ONFI savings card. If they do, all you need to do is submit a
photocopy of your card along with your prescription and insurance card information.
For mail-order pharmacies that do not accept loyalty cards, you may qualify for reimbursement by calling 1-855-345-6634, telling them about this,
and requesting a form. Fill it out and return, along with a copy of your receipt.