For Eligible Commercially Insured Patients
Receive your initial prescription for as little as $0*
If you have been asked to pay more than $25 for your prescription of XHANCE, please call: 1-833-4XHANCE
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.
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 Change Healthcare using BIN# 004682 as a Secondary Payer COB with patient responsibility amount and a valid Other Coverage Code (8). Eligible commercially insured patients with coverage for XHANCE may receive their initial prescription of XHANCE (up to a 90-day supply) for an out-of-pocket cost of $0, and may receive subsequent prescription fills of XHANCE (up to a 90-day supply) for an out-of-pocket cost of $25 or less. Maximum benefit for eligible patients is as follows: Initial fill ($490 for 1 unit; $980 for 2-6 units); Refills ($465 for 1 unit; $955 for 2-6 units). Annual max benefit = $13,000.
To the Pharmacist ONLY: For any questions regarding Change Healthcare online processing, please call 1-800-433-4893.
If you are asked to pay more than $25 for your prescription, 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