For up to 4 patches per month and a yearly maximum benefit of $3,635.10.
PATIENT ONLY PAYS$20
In the event that patient out-of-pocket costs in connection with filling a prescription for more than one patch are in excess of $20 despite the maximum $605.85 deferral having been applied, Patient Rx Solutions will work with insurers, prescribers, and the patient to provide the patient with access to the maximum number of prescribed patches the patient is eligible to receive for $20 out-of-pocket.
*This offer is not valid for prescriptions under Medicare (including Medicare Advantage, Part A, B and D Plans), Medicaid, VA, DOD, TRICARE, CHAMPUS, or other federal or state healthcare programs. This offer is not valid for prescriptions in Massachusetts or in any other state that does not permit copay reimbursement consistent with this program. Patients without commercial insurance are not eligible for this program. Unless otherwise indicated on submission form, Sancuso will be dispensed through select ASPN network pharmacy partners; available at participating pharmacies. Kyowa Kirin, Inc., reserves the right to cancel or modify the program at any time. Kyowa Kirin reserves the right to change, rescind, revoke, or discontinue this offer at any time without notice.