For Commercially Insured Patients*
Receive your initial prescription for $0.
Refills $30 per unit or less for covered patients, $50 per unit maximum for non-covered patients through our preferred pharmacy network. Please call -1-833-4XHANCE.
If you have been asked to pay more than $50 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.
Eligible commercially insured patients pay $0 for initial XHANCE 30-day prescription, and then patients with coverage for XHANCE pay a copay of $30 or less per unit on subsequent. Insured not covered and cash paying patients, Optinose will pay the first $100 per unit. Patients will be responsible for the remaining balance.
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 for the specified. Offer is not valid for prescription costs paid for entirely by insurance plans. Cash discount cards and other non-insurance plans are not valid as primary under this offer.
Pharmacist 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 Therapy First Plus using BIN# 004682 as a Secondary Payer COB with patient responsibility amount and a valid Other Coverage Code (8). Eligible commercially insured patients pay as little as $0 for their initial XHANCE 30-day prescription, maximum benefit available for initial prescription is two units, and then pay a copay of $30 or less per unit on subsequent prescription fills.
Pharmacists for Insured not Covered and Cash Paying Patients: Submit to Therapy First Plus, a valid other coverage code, (eg. 0, 1, 3) is required. Optinose will pay the first $100 per unit. Patients will be responsible for the remaining balance. You will be reimbursed this amount from Therapy First Plus. Pharmacist or eligible patients may call 1-833-4XHANCE for other offers that may be available.
To the Pharmacist ONLY: For any questions regarding Therapy First Plus online processing, please call 1-800-433-4893.
This offer is valid for patients 18 years of age or older and is good for use only with a valid prescription for XHANCETM.
Patients with questions on this offer, please call 1-833-XHANCE1.
Please see full Prescribing Information at www.XHANCE.com