TERMS, CONDITIONS AND ELIGIBILITY
COMMERCIALLY INSURED PATIENTS WITH COVERAGE FOR XHANCE
Commercially insured patients who have coverage for XHANCE (covered patients) will receive their initial XHANCE 30 day prescription fill for as little as $0.
Covered patients who fill their prescription through the XHANCE Preferred Pharmacy Network (PPN), have at least one refill on their prescription and enroll or are enrolled in a qualifying auto-refill program through a participating PPN pharmacy, will receive XHANCE refills for as little as $0.
Covered patients filling their prescription through the XHANCE Preferred Pharmacy Network who do not participate in a qualifying auto-refill program, as well as covered patients utilizing the XHANCE copay card at a retail pharmacy, will pay as little as $0 for their initial 30-day fill and $30 or less / unit for XHANCE refills.
COMMERCIALLY INSURED PATIENTS WITHOUT COVERAGE FOR XHANCE
Commercially insured patients who do not have coverage (non-covered patients) for XHANCE and fill their prescription through the XHANCE Preferred Pharmacy Network will receive their initial XHANCE 30-day prescription fill for as little as $0 and will pay $50 or less per unit for refills.
Optinose will pay the first $100 per unit for non-covered patients filling their XHANCE prescription outside of the XHANCE Preferred Pharmacy Network when utilizing the XHANCE copay card. Patients will be responsible for the remaining balance.
CASH PAYING PATIENTS
Optinose will pay the first $100 per unit for cash paying patients when utilizing the XHANCE copay card. Patients will be responsible for the remaining balance.
ADDITIONAL TERMS AND CONDITIONS
- These offers are valid for patients 18 years of age or older and are good for use only with a valid prescription for XHANCE®.
- These offers are 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 these offers without notice. These offers are good only in the USA, including Puerto Rico, at participating retail pharmacies. Void if prohibited by law, taxed, or restricted.
- These offers are not valid for prescriptions costs paid or reimbursed entirely by health benefit programs. Cash discount cards and other non-insurance plans are not valid as primary under these offers.
- Patient support benefits are limited to no more than two units per 30 day prescription fill.
- These offers and the XHANCE co-pay card have no cash value and may not be used in combination with any other discount, coupon, rebate, free trial, or similar offer. Out of pocket expenses for patients filling XHANCE prescriptions outside of the XHANCE Preferred Pharmacy Network or without the use of the XHANCE copay card may vary.
Eligible patients may call 1-833-XHANCE1 for other offers that may be available.
PREFERRED PHARMACY NETWORKPARTICIPATING PHARMACIES:
|Pharmacy||Address||City, State, Zip||Patient Call-in #||States Serviced|
|Amar Pharmacy||2500 W. Higgins Rd, Suite 450||Hoffman Estates, IL 60169||1-847-944-8261||IL|
|KnippeRx Specialty Pharmacy||1250 Patrol Road, Suite 100||Charlestown, IN 47111||1-877-811-1012||National|
|Professional Arts Pharmacy||128 Curran Lane||Lafayette, LA 70506||1-888-237-4737||AL, GA, LA, MS, SC, TN, TX|
|Palliative Pharmacy Solutions||620 Guilbeau Road||Lafayette, LA 70506||1-844-200-9770||AL, LA|
|Family Pharmacy||13707 Coursey Boulevard, Suite B||Baton Rouge, LA 70817||1-225-636-5229||AL, LA|
|Allied Pharmacy||15200 Shady Grove Road, Suite 101||Rockville, MD 20850||1-301-527-0370||DC, MD, VA|
|DirectRx Pharmacy||830 Kirts Boulevard, Suite 300||Troy, MI 48084||1-855-362-3397||Michigan|
|Foundation Care||4010 Wedgeway Court||Earth City, MO 63045||1-833-494-2623||National|
|Goldsmith Medicenter Pharmacy||777 S New Ballas Rd||St. Louis, MO 63141||1-314-432-5020||Missouri|
|Blink Pharmacy||536 Broadway 2nd Floor||New York, NY 10012||1-314-356-2943||CT, MA, NY, PA, RI|
|Redline Specialty Pharmacy||2415 Osborne Drive East, Suite 100||Hastings, NE 68901||1-888-772-7108||IA, KS, NE|
|White Oak Pharmacy||88 Union Ave||Nutley , NJ 07110||1-973-667-1434||NJ, NY|
|Greenhill||164 Parsippany Road||Parsippany, NJ 07054||1-973-887-9444||NJ, NY|
|Hometown Pharmacy||36A Main Street||Bloomingdale, NJ 07403||1-973-838-0909||NJ, NY|
|Navrexa Pharmacy||609 Berlin Cross Keys Rd, Ste D1||Sicklerville, NJ 08081||1-856-818-4040||New Jersey|
|Cottrill's Pharmacy||255 Main Street||Arcade, NY 14009||1-716-508-8481||New York|
|Medical Center Specialty Pharmacy||912 S. 16th Street||Wilmington, NC 28401||1-800-930-8785||GA, NC, SC|
|North State Pharmacy||3434 Edwards Mill Road, Suite 100||Raleigh, NC 27612||1-984-444-6135||North Carolina|
|Wellness Pharmacy||2601 Blue Ridge Road, Suite 100||Raleigh, NC 27607||1-919-964-5656||North Carolina|
|Lakeside Pharmacy||9615 Sherrill Estates Road #B||Huntersville , NC 28078||1-980-441-8600||North Carolina|
|Gentry Pharmacy||33381 Walker Rd, Suitre A||Avon Lake , OH 44012||1844-443-6879||Ohio|
|Alexa Pharmacy||919 Tyson Ave||Philadelphia, PA 19111||1-215-437-7504||Pennsylvania|
|Meds in Motion Pharmacy||3798 South 700 East, Suite 7||Salt Lake City , UT 84106||1-855-506-6999||CO, NV, NM, UT, WA, CA|
|Meds in Motion Pharmacy||1200 E 3900 South, Room #H||Salt Lake City, UT 84124||1-801-270-0600||CO, WA|
|Meds in Motion Pharmacy||555 West State Road 164, Suite 110||Salem, UT 84653||1-801-335-9180||CO, WA|
|Loudoun Pharmacy||23590 Overland Drive, Suite 130||Sterling, VA 20166||1-571-223-7701||DE, DC, MD, VA, WV|
|Coastal Pharmacy||6160 Kempsville Circle, Suite 104A||Virginia Beach, VA 23502||1-757 800-1601||Virginia|
|RVA Pharmacy||7801 W. Broad Street, Suite 19||Richmond, VA 23294||1-804-528-5589||Virginia|
|Henrico Pharmacy||8705 W. Broad St.||Henrico, VA 23294||1-804-239-1991||Virginia|
|NowRx||2224 Old Middlefield Way, Suite J||Mountain View, CA 94043||1-650-386-5761||California|
|King’s Pharmacy & Compounding Center||16205 Sand Canyon Avenue, Suite 105||Irvine, CA 92618||1-949-387-0780||California|
|SMP Pharmacy Solutions||6050 South Dixie Highway||Miami, FL 33143||1-855-650-5009||Florida|
|Elite Specialty Pharmacy||10210 101st Ave||Ozone Park, NY 11416||1-877-577-1447||New York|
|Cottrill’s Pharmacy||4919 Ellicott Road||Orchard Park, NY 14127||1-716-508-8481||New York|
|Choice Specialty Pharmacy||1403 Highway 6, Suite 700A||Sugar Land, TX 77478||1-832-944-6112||Texas|
|Choice Specialty Pharmacy||8850 Six Pines Drive, Suite 150||The Woodlands, TX 77380||1-346-309-4800||Texas|
|StarCare Pharmacy||321 North Preston Road, Suite B||Prosper, TX 75078||1-972-347-6331||LA, MS, OK, TX|
|Frisco Pharmacy||14550 SH-121, Suite 150||Frisco, TX 75035||1-469-305-7058||LA, MS, OK, TX|
|WeCare Pharmacy||2911 W. 15th Street||Plano, TX 75075||1-972-439-1900||Texas|
|Reliant Pharmacy||403 S. Oxford Valley Rd STE 2||Fairless Hills, PA 19030||1-215-547-1700||Pennsylvania|
|Keystone Care Pharmacy||203 North Broad Street||Lansdale, PA 19446||1-267-691-1600||Pennsylvania|
|Burgh Pharmacy||7206 Mcknight Road Suite 103||Pittsburgh, PA 15237||1-412-837-3702||Pennsylvania|
|Stoneview Pharmacy||459 N Gilbert Rd Ste A-148||Gilbert, AZ 85234||1-480-809-4289||Arizona|
|Newport Lido Pharmacy||351 Hospital Road, Suite 211||Newport Beach , CA 92663||1-949-764-6580||CA, NV|