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|
|Acutus 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|