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 NETWORK

PARTICIPATING PHARMACIES:
 
Pharmacy Address City, State, Zip Patient Call-in # States Serviced
Actus RX 385 W. John Street Hicksville, New York 11801 516-548-5558 NY,NJ,CT,PA
Family Pharmacy 13707 Coursey Boulevard, Suite B Baton Rouge, LA 70817 225-636-5229 AL, LA, TX
Foundation Care 4010 Wedgeway Court Earth City, MO 63045 314-291-1122 National
King's Pharmacy & Compounding Center 16205 Sand Canyon Avenue, Suite 105 Irvine, CA 92618 949-387-0780 CA
KnippeRx Specialty Pharmacy 1250 Patrol Road, Suite 100 Charlestown, IN 47111 877-811-1012 IL,WI,MN,NE, OH,KY,IN,MO,OH,KS
Loudoun Pharmacy 23590 Overland Dr. #130 Sterling VA 20166 571-290-7910 VA, MD, DC, WV, DE
Meds in Motion Pharmacy 12101 South State Street, Suite 101 Draper, UT 84020 855-506-6999 Utah
Meds in Motion Pharmacy 4624 South Holladay Blvd, Suite 101 Salt Lake City, UT 84117 855-506-6999 CA
Meds in Motion Pharmacy 3798 South 700 East, Suite 7 Salt Lake City, UT 84106 855-506-6999 CO, AZ, WA
North State Pharmacy 3434 Edwards Mill Road, Suite 100 Raleigh, NC 27612 984-444-6135 NC
Palliative Pharmacy Solutions 620 Guillbeau Road Lafayette, LA 70506 337-262-9777 AL, LA, TX
Professional Arts Pharmacy 128 Curran Lane Lafayette, LA 70506 337-991-0101 AL, LA, TX
Wellness Pharmacy 2601 Blue Ridge Road, Suite 100 Raleigh, NC 27612 919-964-5656 NC