Welcome Addyi

Welcome to the Sprout Access Activation Site

This program is only available to residents of the United States and US territories, where specified. Most commercially insured and eligible uninsured patients are eligible. This offer is not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare, TRICARE, the Veterans Administration, the Puerto Rico Government Health Insurance Plan or any other federal or state healthcare programs. If your insurance changes, you may no longer be eligible to use this coupon. Coupons can only be processed exclusively at participating pharmacies.

To activate your coupon, please answer the following questions:

Patient First Name:

Patient Last Name:

Address 1:

Address 2:

City:

State:

E-Mail Address:

Phone Number:

Preferred Method of Contact:

Please enter the date of birth of the patient who will use this coupon.

Please enter the 5 digit zip code of the residence of the patient who will use this coupon.

Are prescriptions of the patient who will use this coupon paid in part or in full under any federal, state, or other governmental programs, including, but not limited to, Medicare (including Medicare Advantage and Part A, B, and D plans), Medicaid, TRICARE, Veterans Administration or Department of Defense health coverage, CHAMPUS, the Puerto Rico Government Health Insurance plan or any other federal or state healthcare programs?

Yes No

Does the patient who will use this coupon have commercial (in part or in whole) prescription coverage?

Yes No

Please confirm that, by activating this coupon, you have read, understand and will comply with the terms and conditions of the program and that you currently meet all eligibility criteria.

Yes No

You understand that the personal information you provide and information pertaining to the use of your coupon at the pharmacy will be shared with Sprout Pharmaceuticals, and third parties working with (or for) Sprout Pharmaceuticals. You also authorize Sprout Pharmaceuticals, and companies working with or for it, to communicate with you by email, phone or text message at the number I have provided about products, including marketing materials, health conditions, co-pay and financial assistance. You agree to be contacted by mail, email, and/or at the phone number you provide. You may opt out of individual communications entirely at any time by calling 855-280-0581.
Sprout Pharmaceuticals and companies providing services to Sprout Pharmaceuticals will not sell or rent your personally identifiable information, as described in the Privacy Policy, which you can view by visiting http://sproutpharma.com/privacy

Yes No

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Eligibility Criteria/Terms and Conditions:

By using the coupon, you confirm that you understand and agree to comply with the following terms and conditions of this offer:

This offer is only valid for eligible patients with commercial insurance and eligible uninsured patients.
This offer is not valid for any person eligible for reimbursement of prescriptions, in whole or in part, by any federal, state, or other governmental programs, including, but not limited to, Medicare (including Medicare Advantage and Part A, B, and D plans), Medicaid, TRICARE, Veterans Administration or Department of Defense health coverage, CHAMPUS, the Puerto Rico Government Health Insurance Plan, or any other federal or state health care programs.
You agree not to seek reimbursement for all or any part of the benefit received through this offer and are responsible for making any required reports of your use of this offer to any insurer or other third party who pays any part of the prescription filled.
This offer is good only in the United States of America (including the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands) at retail pharmacies. This offer is not valid where otherwise prohibited, taxed, or otherwise restricted.
You must be 18 years of age or older to redeem this offer for yourself or a minor.
You must present this coupon along with your prescription to participate in this program.
This coupon is good for use only with the products identified herein. No other purchase is necessary.
This offer cannot be redeemed at government-subsidized clinics.
Reimbursement limitations may apply based on patient‘s individual insurance plan rules and patient‘s deductible; therefore, patient‘s out-of-pocket expense may vary. Patient is responsible for all additional costs and expenses after reimbursement limits are reached.
This coupon and offer are not health insurance.
The selling, purchasing, trading, or counterfeiting of this coupon is prohibited by law. Void if reproduced.
This offer is not valid with other offers. This coupon has no cash value. No cash back.
Sprout Pharmaceuticals reserves the right to rescind, revoke, terminate, or amend this offer at any time, without notice.
You understand and agree to comply with the terms and conditions of this offer as set forth above at www.activatethecard.com/sprout/addyi.
For questions call: 1-855-280-0581.