Welcome to the ZYDELIG® Copay Coupon Program
Start with these 2 simple steps
After you are prescribed ZYDELIG, review the Eligibility Requirements and Terms and Conditions below.
Request your ZYDELIG® Copay Coupon Card (or request activation for one you already have) by clicking on the appropriate button above. Fill out the form to proceed.
Privacy Statement / Legal Information
You are eligible for the Copay Coupon Program if you meet all of the terms and conditions below, including if you:
you are enrolled in a government healthcare prescription drug program, such as Medicare Part D or Medicaid. Also, if you are in the Medicare Part D coverage gap, or "donut hole," you are not eligible. Other financial assistance may be available for you. To learn more, please call ZYDELIG AccessConnect™ at 1-844-6ACCESS (1-844-622-2377).
- Have commercial prescription drug insurance coverage that does not cover all of your out-of-pocket cost
- Have commercial prescription drug insurance coverage that does not cover ZYDELIG
- Have no insurance
Terms and Conditions
- The Gilead Copay Coupon Card ("Card") can be used only by eligible residents of the U.S., Puerto Rico, or U.S. territories at participating eligible retail, specialty, or mail-order pharmacies in the U.S., Puerto Rico, or U.S. territories. Product must originate in the U.S., Puerto Rico, or U.S. territories. You must be 18 years or older to use the Card for yourself or a minor.
- The Card is limited to one per person and is not transferable. No substitutions are permitted. This Card is available for each valid prescription. The offer cannot be combined with any other coupon, free trial, discount, prescription savings card, or other offer. Patient may not be currently receiving free drug assistance through Gilead Sciences, Inc. ("Gilead")'s patient assistance programs.
- The Card is not insurance and is not intended to substitute for insurance.
- The Card is valid only for patients with commercial insurance or cash-pay patients and is not valid for prescriptions that are eligible to be reimbursed:
- - in whole or part, by Medicare, Medicaid or a Medicare Part D plan, TRICARE, VA, DoD, Puerto Rico Government Health Insurance Plan
("Healthcare Reform"), or any other federal or state-funded healthcare benefit program (collectively, "Government Programs"); or
- - by commercial plans or other health or pharmacy benefit programs that reimburse for the entire cost of prescription drugs.
- Patients without insurance coverage or who have commercial insurance that does not cover the Gilead products are considered "cash-pay" patients. Medicare Part D enrollees who are in the prescription drug coverage gap (the "donut hole") are not considered cash-pay and are not eligible to use the Card. Patients who begin receiving prescription benefits from such Government Programs at any time will no longer be eligible to use the Card. Void where prohibited by law, taxed, or restricted.
- Patient, pharmacist, and prescriber agree not to seek reimbursement for all or any part of the benefit received by the patient through the offer. Both patient and pharmacist are each individually responsible for reporting receipt of coupon benefit to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the Card, as required.
- It is illegal to sell, purchase, trade, or counterfeit, or offer to sell, purchase, trade, or counterfeit the Card.
- Gilead reserves the right to terminate, rescind, revoke, or modify this Card at any time without notice.