UBRELVY COMPLETE SAVINGS CARD SIGNUP
NOW ELIGIBLE PATIENTS MAY PAY AS LITTLE AS $0* FOR UBRELVY—THAT MAY MEAN NO COST TO YOU
Not actual card
PROGRAM TERMS, CONDITIONS, AND ELIGIBILITY CRITERIA:
1. This offer is valid for patients 18 years of age or older and is good for use only with a valid prescription for UBRELVY® (ubrogepant) tablets at the time the prescription is filled by the pharmacist and dispensed to the patient.
2. This offer is not valid for use by patients enrolled in Medicare, Medicaid, or other federal or state programs (including any state pharmaceutical assistance programs) or private indemnity or HMO insurance plans that reimburse you for the entire cost of your prescription drugs. If at any time a participating patient begins receiving prescription drug coverage under any federal, state, or government-funded healthcare program, the patient will no longer be eligible for this program and must cease participation. This offer is not valid for cash-paying patients.
3. Eligible commercially insured patients may pay as little as $0 per monthly prescription fill. Patient out-of-pocket expense will vary; check with your pharmacist for your co-pay discount. Restrictions, including monthly, quarterly, and/or annual maximums, may apply.
4. Subject to all other terms and conditions, a commercially insured patient whose plan covers UBRELVY may receive up to a maximum annual savings of $7,000 per calendar year, solely for the patient’s benefit, under this program. Commercially insured patients for whom coverage is not available because the insurer has not established a coverage review process may be eligible to receive up to 4 one-month fills at no charge. Under this program, once an insurer has established a review process for coverage requests, commercially insured patients may receive up to a maximum of 2-month fills at no charge for an FDA-approved indication while coverage is pending.
5. Patients may not seek reimbursement for value received from this savings program from any third-party payers.
6. AbbVie reserves the right to rescind, revoke, or amend this offer without notice.
7. Offer good only in the USA, including Puerto Rico, at participating retail pharmacies. Patients residing in or receiving treatment in certain states may not be eligible to participate in this program.
8. Void if prohibited by law, taxed, or restricted.
9. This card is not transferable. The selling, purchasing, trading, or counterfeiting of this card is prohibited by law.
10. This card has no cash value and may not be used in combination with any other discount, coupon, rebate, free trial, or similar offer for the specified prescription.
11. This offer is not health insurance.
12. By redeeming this offer, you acknowledge that you are an eligible commercially insured patient and that you understand and agree to comply with the above terms and conditions.
For questions about the program, including savings on mail-order prescriptions, or to activate your card ID, please call 1-844-577-6239.
To learn about AbbVie’s privacy practices and your privacy choices, visit https://abbv.ie/corpprivacy.