TERMS, CONDITIONS AND ELIGIBILITY
COMMERCIALLY INSURED PATIENTS WITH COVERAGE FOR XHANCE® (fluticasone propionate Nasal Spray)
Commercially insured patients who have coverage for XHANCE (covered patients) will receive their initial XHANCE 30-day prescription for an out-of-pocket cost of $0.
Covered patients who fill their prescription through the XHANCE Preferred Pharmacy Network (PPN), and are enrolled in a qualifying refill program through a participating PPN pharmacy, will receive their XHANCE refills (30-day supply) for an out-of-pocket cost of $0.
Covered patients filling their prescription through the XHANCE Preferred Pharmacy Network who do not participate in a qualifying refill program, as well as covered patients utilizing the XHANCE copay card at a retail pharmacy, will receive their XHANCE refills (30-day supply) for an out-of-pocket cost of $30 or less perunit.
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 an out-of-pocket cost of $0 and will pay an out-of-pocket cost of $50 or less per unit for refills (30-day supply).
For non-covered patients who fill their XHANCE prescription outside of the XHANCE Preferred Pharmacy Network, Optinose will pay up to the first $100 per unit 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®.
- Patients who are enrolled in a state or federally funded prescription insurance program are not eligible for this offer. This includes patients enrolled in Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DOD) programs or TriCare. If you are enrolled in a state or federally funded prescription insurance program, you may not use this offer even if you elect to be processed as an uninsured (cash-paying) patient.
- Out-of-pocket costs paid by these programs 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).
- These offers are not insurance and are restricted to residents of the United States, including Puerto Rico, at participating pharmacies. Void where 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 XHANCE 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.
Last updated: June, 2020.
PREFERRED PHARMACY NETWORKPARTICIPATING PHARMACIES:
|Pharmacy||Address||City, State, Zip||Patient Call-in #||States Serviced|
|Alexa Pharmacy||919 Tyson Ave||Philadelphia, PA 19111||1-215-437-7504||Pennsylvania|
|Allied Pharmacy||15200 Shady Grove Road, Suite 101||Rockville, MD 20850||1-301-527-0370||DC, MD, VA|
|Amar Pharmacy||2500 W. Higgins Rd, Suite 450||Hoffman Estates, IL 60169||1-847-944-8261||IL|
|Blink Pharmacy||536 Broadway 2nd Floor||New York, NY 10012||1-314-356-2943||CT, MA, NY, PA, RI|
|Burgh Pharmacy||7206 Mcknight Road Suite 103||Pittsburgh, PA 15237||1-412-837-3702||Pennsylvania|
|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|
|Coastal Pharmacy||6160 Kempsville Circle, Suite 104A||Virginia Beach, VA 23502||1-757 800-1601||Virginia|
|Cottrill's Pharmacy||255 Main Street||Arcade, NY 14009||1-716-508-8481||New York|
|Cottrill’s Pharmacy||4919 Ellicott Road||Orchard Park, NY 14127||1-716-508-8481||New York|
|DirectRx Pharmacy||830 Kirts Boulevard, Suite 300||Troy, MI 48084||1-855-362-3397||Michigan|
|Elite Specialty Pharmacy||10210 101st Ave||Ozone Park, NY 11416||1-877-577-1447||New York|
|Family Pharmacy||13707 Coursey Boulevard, Suite B||Baton Rouge, LA 70817||1-225-636-5229||AL, LA|
|Foundation Care||4010 Wedgeway Court||Earth City, MO 63045||1-833-494-2623||National|
|Frisco Pharmacy||14550 SH-121, Suite 150||Frisco, TX 75035||1-469-305-7058||LA, MS, OK, TX|
|Gentry Pharmacy||33381 Walker Rd, Suitre A||Avon Lake , OH 44012||1844-443-6879||Ohio|
|Goldsmith Medicenter Pharmacy||777 S New Ballas Rd||St. Louis, MO 63141||1-314-432-5020||Missouri|
|Greenhill||164 Parsippany Road||Parsippany, NJ 07054||1-973-887-9444||NJ, NY|
|Henrico Pharmacy||8705 W. Broad St.||Henrico, VA 23294||1-804-239-1991||Virginia|
|Hometown Pharmacy||36A Main Street||Bloomingdale, NJ 07403||1-973-838-0909||NJ, NY|
|Keystone Care Pharmacy||203 North Broad Street||Lansdale, PA 19446||1-267-691-1600||Pennsylvania|
|King’s Pharmacy & Compounding Center||16205 Sand Canyon Avenue, Suite 105||Irvine, CA 92618||1-949-387-0780||California|
|KnippeRx Specialty Pharmacy||1250 Patrol Road, Suite 100||Charlestown, IN 47111||1-877-811-1012||National|
|Lakeside Pharmacy||9615 Sherrill Estates Road #B||Huntersville , NC 28078||1-980-441-8600||North Carolina|
|Loudoun Pharmacy||23590 Overland Drive, Suite 130||Sterling, VA 20166||1-571-223-7701||DE, DC, MD, VA, WV|
|Medical Center Specialty Pharmacy||912 S. 16th Street||Wilmington, NC 28401||1-800-930-8785||GA, NC, SC|
|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|
|Navrexa Pharmacy||609 Berlin Cross Keys Rd, Ste D1||Sicklerville, NJ 08081||1-856-818-4040||New Jersey|
|Newport Lido Pharmacy||351 Hospital Road, Suite 211||Newport Beach , CA 92663||1-949-764-6580||CA, NV|
|North State Pharmacy||3434 Edwards Mill Road, Suite 100||Raleigh, NC 27612||1-984-444-6135||North Carolina|
|NowRx||2224 Old Middlefield Way, Suite J||Mountain View, CA 94043||1-650-386-5761||California|
|Palliative Pharmacy Solutions||620 Guilbeau Road||Lafayette, LA 70506||1-844-200-9770||AL, LA|
|Professional Arts Pharmacy||128 Curran Lane||Lafayette, LA 70506||1-888-237-4737||AL, GA, LA, MS, SC, TN, TX|
|Redline Specialty Pharmacy||2415 Osborne Drive East, Suite 100||Hastings, NE 68901||1-888-772-7108||IA, KS, NE|
|Reliant Pharmacy||403 S. Oxford Valley Rd STE 2||Fairless Hills, PA 19030||1-215-547-1700||Pennsylvania|
|RVA Pharmacy||7801 W. Broad Street, Suite 19||Richmond, VA 23294||1-804-528-5589||Virginia|
|SMP Pharmacy Solutions||6050 South Dixie Highway||Miami, FL 33143||1-855-650-5009||Florida|
|StarCare Pharmacy||321 North Preston Road, Suite B||Prosper, TX 75078||1-972-347-6331||LA, MS, OK, TX|
|Stoneview Pharmacy||459 N Gilbert Rd Ste A-148||Gilbert, AZ 85234||1-480-809-4289||Arizona|
|WeCare Pharmacy||2911 W. 15th Street||Plano, TX 75075||1-972-439-1900||Texas|
|Wellness Pharmacy||2601 Blue Ridge Road, Suite 100||Raleigh, NC 27607||1-919-964-5656||North Carolina|
|White Oak Pharmacy||88 Union Ave||Nutley , NJ 07110||1-973-667-1434||NJ, NY|