Patient Savings and Support Options

Co-pay Program Terms and Conditions:

• By participating in this savings program, participants understand and agree that the information provided, as well as non-personally identifiable information obtained from the pharmacy, will be shared with the manufacturer and with any companies working with the manufacturer. Participants also affirm that they will not submit, and have not had submitted on their behalf, a claim for reimbursement or coverage for items purchased with this card under Medicaid, Medicare, TRICARE, or any other federal or state government healthcare program, or where prohibited by state law. By using the Arynta® Copay card, you confirm that you understand and agree to comply with program rules, regulations, and terms and conditions.
• Must be 6 years of age or older to redeem this copay card. The patient must have a valid prescription.
• The program is not valid for prescriptions that are eligible for reimbursement, in part or in full by Medicaid, Medicare, TRICARE, Department of Veteran Affairs, Department of Defense, or other federal or state healthcare programs (including any state prescription drug assistance programs, not including Puerto Rico).
• This copay card is only valid for eligible patients with private/commercial insurance and Not Covered Patients. “Not Covered Patients” are defined as those patients who have commercial insurance and the drug is not covered on the plan’s formulary or has an NDC block, prior authorization, step edit, or other restriction that has not been met. Reimbursement limitations may apply. Patients are responsible for all additional costs and expenses after reimbursement limits are reached, including additional copayment and coinsurance amounts.
• This program is not valid for prescriptions that are eligible for reimbursement by private insurance plans or other health or pharmacy benefit programs that reimburse you for the entire cost of your prescription drugs.
• The Co-pay assistance offer is not transferable.
• The program cannot be combined with any other rebate, coupon, free trial, cash discount card, voucher, or similar offer for the specified prescription.
• The Co-pay Program is not health insurance.
• This offer is good only in the United States as allowed by law.
• Azurity and its service providers reserve the right to rescind, recall, revoke, or amend this without notice at any time.
• For questions regarding the Co-pay assistance, please call (833) 442-2313.