If you have any questions please call 1-833-XHANCE1

Your savings card is active and ready to use today. To start saving now, please print your savings card and present it at your next visit to the pharmacy.

This offer is valid for patients 18 years of age or older and is good for use only with a valid prescription for XHANCE®.

Terms and Conditions

This offer is not valid for use by patients enrolled in Medicare, Medicaid and TRICARE or other federal or state programs. Optinose reserves the right to rescind, revoke, or amend this offer without notice. Offer good only in the USA, including Puerto Rico, at participating retail pharmacies. Void if prohibited by law, taxed, or restricted. This card has no cash value and may not be used in combination with any other discount, coupon, rebate, free trial, or similar offer. Offer is not valid for prescription costs paid for entirely by health benefit plans. Copay support paid through this offer to reduce a patient’s out-of-pocket costs may not be submitted as a claim for payment to any third-party payer, pharmaceutical patient assistance foundation, or account such as a Flexible Spending Account (FSA), a Health Savings Account (HSA), or a Health Reimbursement Account (HRA). Cash discount cards are not commercial payers and are not eligible to be used in conjunction with this offer. By accepting this offer or using this card, patient authorizes the transfer of his XHANCE prescription to any pharmacy within the XHANCE Preferred Pharmacy Network.

Pharmacist for a Patient with an eligible commercial 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 eligible commercial payer first, then submit the balance due to Capital Rx using BIN# 610852 as a Secondary Payer COB with patient responsibility amount and a valid Other Coverage Code (8). Annual maximum benefits and maximum benefits per fill apply. Patient cost share may impact benefits and eligibility. Annual maximum benefit limits apply. See XHANCE.com/terms-and-conditions for addtional terms and conditions.

To the Pharmacist ONLY: For any questions regarding Capital Rx online processing, please call 1-844-306-9173.

To the Patient ONLY: Please call 1-833-4XHANCE to be connected to a pharmacy participating in the XHANCE Preferred Pharmacy Network and for other offers that may be available.

Please see full Prescribing Information at www.XHANCE.com