Savings and Support Made Simple
START AND STAY ON TRACK FOR AS LITTLE AS $0 WITH 3 EASY STEPS
1. ENROLL NOW
2. START SAVING
3. GET SUPPORT
Home delivery may be an option for you. Contact your pharmacy or insurance provider to learn more.
A Support Specialist will call you within 1 business day.
Questions? Support is only a phone call away. Call 1-855-QULIPTA (1-855-785-4782) Monday through Friday, 8 AM-8 PM ET.
* Terms and Conditions apply. This benefit covers QULIPTA™ (atogepant). Eligibility: Available to patients with commercial prescription insurance coverage for QULIPTA who meet eligibility criteria. The program is not available to cash-paying patients or patients receiving prescription reimbursement under any federal, state, or government-funded insurance programs (for example, Medicare [including Part D], Medicare Advantage, Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs programs) or where prohibited by law or by the patient’s health insurance provider. If at any time a patient begins receiving prescription drug coverage under any such federal, state, or government-funded healthcare program, patient will no longer be able to use the QULIPTA Complete Savings Card and patient must call 1.855.QULIPTA to stop participation. Under this program, an eligible patient whose insurer has imposed coverage restrictions that have not been satisfied may receive up to a maximum of two 30-day fills at no charge for an FDA approved indication while coverage is pending. This payment may not be applied towards any out-of-pocket limits or other deductibles under patient’s insurance coverage. Patients residing in or receiving treatment in certain states may not be eligible. Patients may not seek reimbursement for value received from QULIPTA Complete from any third-party payers. Offer subject to change or discontinuance without notice. Restrictions, including monthly maximums, may apply. This assistance offer is not health insurance. 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. To learn about AbbVie’s privacy practices and your privacy choices, visit www.abbvie.com/privacy.html.
†QULIPTA Complete Support Specialists are provided by AbbVie and do not work under the direction of your healthcare professional (HCP) or give medical advice. They are trained to direct patients to their HCP for treatment-related advice, including further referrals.
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Your insurance information will be used to determine your eligibility for the QULIPTA Complete Savings Card.
*For eligible, commercially insured patients. Terms and Conditions apply. View them in full.
QULIPTA Complete is an AbbVie-sponsored program that provides personalized patient support (“QULIPTA Complete”). The categories of personal information AbbVie, its affiliates, collaborators and agents (“AbbVie”) collect in this Enrollment Form may include contact, insurance, prescription, and medical history information. The personal information collected will be used to provide and manage the QULIPTA Complete program and to perform research and analytics on a de-identified basis.
For more information about the categories of personal information collected by AbbVie and the purposes for which AbbVie uses personal information, visit www.abbvie.com/privacy.html.
*Terms and Conditions apply. This benefit covers ORIAHNN™ (elagolix, estradiol, and norethindrone acetate capsules; elagolix capsules). Eligibility: Available to patients with commercial prescription insurance coverage for ORIAHNN who meet eligibility criteria. Copay assistance program is not available to patients receiving prescription reimbursement under any federal, state, or government-funded insurance programs (for example, Medicare [including Part D], Medicare Advantage, Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs programs) or where prohibited by law or by the patient’s health insurance provider. If at any time a patient begins receiving prescription drug coverage under any such federal, state, or government-funded healthcare program, patient will no longer be able to use the Oriahnn Complete Savings Card and patient must call Oriahnn Complete at 1-800-ORIAHNN and stop use of the copay card. Patients residing in or receiving treatment in certain states may not be eligible. Patients may not seek reimbursement for value received from Oriahnn Complete, including the copay card, from any third-party payers. Offer subject to change or discontinuance without notice. Restrictions, including monthly maximums, may apply. This is not health insurance.
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