Terms & Conditions: Patients are not eligible for copay assistance if prescriptions are paid in part or full by any state or federally funded programs (Federal Employees Health Benefits [FEHB] Program members may participate in co-pay reimbursement programs), including but not limited to Medicare or Medicaid, Medigap, VA, DOD, or TRICARE® and where prohibited by law. The free trial and copay prescriptions shall not be submitted for reimbursement to any private or public third-party payer, including Medicaid or Medicare, or any other similar federal or state healthcare program. Offer is valid in the USA.
14-Day Free Trial—To the Patient: Present the 14-day free trial voucher to the pharmacist. The program is available to all patients regardless of payer, excluding where prohibited by law. Present this voucher to the pharmacist along with your prescription to participate in this program. If you have any questions or if you wish to discontinue your participation in the program, call 1-855-345-6634 (8:00 am-8:00 pm ET, Monday through Friday).
Copay Assistance To the Patient: Patients paying cash and most of those with commercial prescription insurance may enroll. Present your activated card to the pharmacist along with your prescription to participate in this program. If you have any questions or if you wish to discontinue your participation in the program, call 1-855-345-6634 (8:00 am-8:00 pm ET, Monday through Friday). Use of the copay savings program will require patients to pay a minimum of $25 out-of-pocket expense for each 30-day prescription. Card will then be applied toward any remaining out-of-pocket expense up to a maximum of $50. Example: If your total out-of-pocket pharmacy bill exceeds $75 ($25 + $50), you will be responsible for the additional balance.
To the Pharmacist:
- Submit transaction to McKesson Corporation using BIN #610524.
- For the copay card, if primary coverage exists, input card information as secondary coverage and transmit using the COB segment of the NCPDP transaction. Applicable discounts will be displayed in the transaction response.
- Acceptance of this card and your submission of claims are subject to the LoyaltyScript® program. Terms and Conditions posted at www.mckesson.com/mprstnc.
- For questions regarding setup, claim transmission, patient eligibility, or other issues, call the LoyaltyScript® program at 1-888-205-9880 (8:00 am-8:00 pm ET, Monday through Friday).
Lundbeck reserves the right to rescind, revoke, or amend this offer without notice. When you use this card, you are certifying that you understand the program rules, regulations, and terms and conditions. Cards cannot be combined with any other rebate, coupon, free trial, or similar offer.
Patients with no insurance or no coverage may qualify for ONFI® (clobazam) CIV at no cost. Call the ONFI Support Center at 1-855-345-6634 for details. By using the Copay Savings Card, patients agree to the terms and conditions of this program.