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.
  • Optinose reserves the right to rescind, revoke, or amend these offers, eligibility, and terms of use at any time without notice.
  • 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 NETWORK

PARTICIPATING 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