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LinzessSavingCardPDF 2

This document outlines the terms and eligibility criteria for a savings program for LINZESS prescriptions. It is valid for up to 12 prescription fills before March 31, 2023. Eligible patients pay a minimum of $30 for each fill depending on insurance coverage. The program is not valid for government or federal insurance plans.

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131 views

LinzessSavingCardPDF 2

This document outlines the terms and eligibility criteria for a savings program for LINZESS prescriptions. It is valid for up to 12 prescription fills before March 31, 2023. Eligible patients pay a minimum of $30 for each fill depending on insurance coverage. The program is not valid for government or federal insurance plans.

Uploaded by

tqzj54jmxn
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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BIN# 004682

PCN# CN
GRP# EC48006034
ID# 49598242150

Program Terms, Conditions, and Eligibility Criteria:1. This offer is valid only for patients 18 years of age or older and is
good for use only with a valid prescription for LINZESS® (linaclotide) capsules 72 mcg, 145 mcg, or 290 mcg 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 or where prohibited by law
or by the patient’s health insurance provider. Patients may not use this card if they are Medicare-eligible and enrolled in an
employer-sponsored health plan or prescription drug benefit program for retirees. This offer is not valid for cash-paying
patients.3. Depending on your insurance coverage, most eligible patients may pay as little as $30 per 30, 60, or 90-day supply
for each of up to twelve (12) prescription fills. One 60-day supply counts as two (2) fills and one 90-day supply counts as three
(3) fills of the total twelve (12) fills. Check with your pharmacist for your copay discount. Maximum savings limit applies; patient
out-of-pocket expense may vary. 4. This offer is valid for up to twelve (12) prescription fills. Offer applies only to prescriptions
filled before the program expires on 03/31/23. 5. AbbVie reserves the right to rescind, revoke, or amend this offer without
notice. 6. Offer good only in the USA, including Puerto Rico, at participating retail pharmacies. 7. Void if prohibited by law,
taxed, or restricted. 8. If at any time a patient begins receiving prescription drug coverage under any such federal, state, or
government-funded healthcare program, patient will no longer be eligible to use the LINZESS Savings Card. 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. This card expires March 31, 2023. 13. By redeeming this card, you
acknowledge that you are an eligible patient and that you understand and agree to comply with the terms and
conditions of this offer.

For questions about the program, including savings on mail-order prescriptions, please call 1-855-226-3937.

Pharmacist Instructions for a Patient with an Eligible Third Party Payer: When you redeem this card, you certify that
you have not submitted and will not submit a claim for reimbursement under any federal, state, or other government
programs for this prescription. Submit the claim to the primary Third Party Payer first, then submit the balance due to
CHANGE HEALTHCARE as a Secondary Payer COB with patient responsibility amount and a valid Other Coverage Code (eg,
8). If you receive a rejection due to PA, step-edit, or NDC block, submit Other Coverage Code of 03 (secondary claim). Patient
pays the first $30 plus any remaining balance after the maximum savings limit for the program is reached. Reimbursement will
be received from CHANGE HEALTHCARE. For any questions regarding online processing, call the CHANGE HEALTHCARE
Help Desk at 1-800-422-5604.

Please click here for full Prescribing Information, including Boxed Warning, for LINZESS or visit
www.linzess.com.
Program managed by ConnectiveRx on behalf of AbbVie.

Ironwood® and its three-leaf design are registered trademarks of Ironwood Pharmaceuticals, Inc.
LINZESS® and its design are registered trademarks of Ironwood Pharmaceuticals, Inc.
© 2021 AbbVie and Ironwood Pharmaceuticals, Inc. All rights reserved.

LEGAL POLICY | ABBVIE PRIVACY POLICY | IRONWOOD PRIVACY POLICY | TERMS OF USE | CONTACT US | US-LIN-230001

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