Continue reading to learn about our Lupron Depot patient assistance program, and apply today. All rights reserved.Simplefill is committed to helping Americans who are struggling to pay for the prescription medications they need to manage chronic medical conditions such as hormone-responsive cancers. *Max benefit of $250 per monthly prescription fill and $3,000 per calendar year By redeeming this card, you acknowledge that you are an eligible patient and that you understand and agree to comply with the terms and conditions of this offer.This card has no cash value and may not be used in combination with any other discount, coupon, rebate, free trial, or similar offer for the specified prescription. The selling, purchasing, trading, or counterfeiting of this card is prohibited by law. Void if prohibited by law, taxed, or restricted. This offer is not valid for residents of Massachusetts. Offer good only in the USA, including Puerto Rico, at participating pharmacies. Amneal Pharmaceuticals LLC reserves the right to rescind, revoke, or amend this offer without notice.Offer applies only to prescriptions filled before the program expires.

Maximum savings limit applies patient out-of-pocket expense may vary.

This offer is not valid for cash-paying patients. Patients may not use this card if they are Medicare-eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees.

This card is not valid for use by patients enrolled in Medicare, Medicaid, or other federal or state programs (including any state pharmaceutical assistance programs), or private indemnity or HMO insurance plans that reimburse you for the entire cost of your prescription drugs.

This offer is only good for use by patients with a valid prescription for an eligible product with an approved indication at the time the prescription is filled and dispensed to the patient.

Patient will receive a maximum of $250 off per monthly prescription fill for their out-of-pocket cost.įor pharmacy processing questions, please call 33. Submit the SECONDARY claim to PDMI under BIN: 610020. Process a Coordination of Benefits (COB/split bill) claim using the patient’s prescription insurance for the PRIMARY claim. To Pharmacist: Offer valid for SECONDARY claims only. By using this offer, you acknowledge that you meet the Eligibility Criteria and will comply with the Terms and Conditions set forth below. This offer is not valid for Abiraterone Acetate 125mg Tablets. This offer is valid for a maximum savings of $250 per monthly prescription fill, and $3,000 per calendar year. Mention this offer to your pharmacy along with a valid abiraterone acetate 500mg prescription for an FDA-approved use. Prescriptions filled with Amneal Abiraterone Acetate 500mg Tablets. To Patient: Commercially insured patients can use this copay card to reduce out-of-pocket expenses on eligible

If you have any questions, please feel free to call 33.

Eligible commercially insured patients may pay as little as $10* for their monthly Amneal Abiraterone Acetate 500mg Tablets prescription.

Present this card or BIN, Group and ID numbers to your pharmacist along with a valid prescription.

Here’s how the Abiraterone Acetate Copay Card works: *Max benefit of $250 per monthly prescription fill. Pay as little as $10* for each prescription of Amneal Abiraterone Acetate 500mgĮxclusively for Amneal-labeled Abiraterone Acetate 500mg Tablets (NDC: 69238-1754-06 & 60219-1754-06) (opens in a new tab)Ĭlick here for full Prescribing Information.

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Lupron copay assistance