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Savings and Support Made Simple

START AND STAY ON TRACK FOR AS LITTLE AS $0 WITH 3 EASY STEPS

QULIPTA Complete logo

START AND STAY ON TRACK FOR AS LITTLE AS $0 WITH 3 EASY STEPS

1. ENROLL NOW

  • Please provide the information requested below and submit to enroll. You can start using your savings card right away!

2. START SAVING 

  • Eligible, commercially insured patients can pay as little as $0
    a month*
  • If you experience issues with insurance coverage, we offer additional support options to help eligible patients get QULIPTA

3. GET SUPPORT 

  • QULIPTA Complete Insurance Specialists will help you understand your insurance coverage and identify the next steps to getting your prescribed treatment
  • QULIPTA Complete Support Specialists can answer your questions about QULIPTA, and help you establish a daily routine to achieve your personal goals

Home delivery may be an option for you. Contact your pharmacy or insurance provider to learn more.

 

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). Eligible patients will receive copay assistance through one or more forms, such as a savings or copay card, and enrollment requirements may vary. Eligibility: Available to patients with commercial prescription insurance coverage for QULIPTA who meet eligibility criteria. The eligibility criteria varies by the form of copay assistance provided and will be made available to you as part of the enrollment process for the form or forms that you apply to receive. 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, the patient will no longer be able to use the QULIPTA Complete Savings Card, and the patient must call 1.855.QULIPTA to stop participation. Patients may be eligible to receive up to twelve 30-day fills at no charge where coverage is not available until the insurer has established a coverage review process. Under this program, once an insurer has established a review process for coverage requests, eligible patients 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 to enroll in the QULIPTA™ (atogepant) Copay Assistance Program is subject to change, reduction in amount of monetary assistance, or discontinuance without notice. Restrictions, including duration of the QULIPTA™ (atogepant) Copay Assistance program, available form(s) of copay assistance, and monthly maximums, may apply. Call 1.855.QULIPTA for more information. 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

 

To Pharmacists: For further information, please contact 800-364-4767.

 

All fields are required unless marked optional.
When did you start taking QULIPTATM (atogepant)?

If you haven’t started yet, it’s OK to enter your planned start date below.

We ask for your start date so we can get to know you better and provide you with a more personalized treatment experience.

You must be 18 years of age or older to enroll in QULIPTA Complete.

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Date of Birth does not meet the required format

Your email will be used only to provide assistance with this program.

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Email Address is in invalid format

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Address is Required

Your ZIP code will be used only to provide assistance with this program

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Your phone number will be used only to provide assistance with this program.

Your phone number will be used only to provide assistance with this program.

Please enter a valid 5-digit US ZIP code.

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OPT-IN TO RECEIVE SMS MESSAGES ABOUT YOUR MEDICATION

Check your eligibility for the QULIPTA Complete Savings Card

Your insurance information will be used to determine your eligibility for the QULIPTA Complete Savings Card.

The ID# is located on the front of the QULIPTA Complete Savings Card and is 12 characters long. For proper ID# validation, please be sure to input the ID# exactly as it appears on the QULIPTA Savings Card.

${sc.RxBIN}

${sc.RxPCN}

${sc.RxGroup}

${sc.RxIdentifier}

 

Copay Details not found

QULIPTA Complete Savings Card is only available for patients with commercial insurance. Please continue to enroll in QULIPTA Complete and we can help identify potential options to afford your medication and stay on track with your prescribed treatment.

*For eligible, commercially insured patients. Terms and Conditions apply. View them in full.

*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.

Please provide appropriate value in each field's default value property as per Analytics Tech Specs

Form Name:

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Password Resets, Login, Profile, Representative, Contact Us, Polls, Social Share, Doctor Discussion Guide, Dosing Guide, Symptom Checker, Knowledge Assessment, Event, More Info, Sign Up, Saving Card, Benefit Verification, Benefit Enrollments, Medical Exception, Injection Form, Share a Story

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Savings Card, Insurance, Symptom Journal, Test Score Tracker, Condition Information, Doctor Discussion Guide, Dosing Information, Enrollment Form, Flashcard, Medical Exception, Patient Counseling Guide, Savings Card, Symptom Journal, Doctor Discussion Guide, Doctor Search, Dosage Calculator, Enroll, Med Reminders, Quick Poll, Resource Request, Symptom Quiz, UGC Submission, Contact Rep, Savings Card, Social Share, App Store, More Info, Patient Resources, Share Information, Share Results, Submit a Story, Assessment Tool, Benefits Verification, Carousel, Initiation, Myth versus Fact, Workaround Quiz, Formulary Tool, Image Expand, Medical Exception, Q And A, Slider, Administration Instructions, Condition Information, Insurance, Inventory, Mechanism of Action, Patient Story, Product Overview, Program Overview, Injection Training, Other

 

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Please provide appropriate value in each field's default value property as per Analytics Tech Specs

Form Name:

Form Category:

Account Management, Contact, Interactions, Quiz, Registration, Services

 

Form Sub-Category:

Password Resets, Login, Profile, Representative, Contact Us, Polls, Social Share, Doctor Discussion Guide, Dosing Guide, Symptom Checker, Knowledge Assessment, Event, More Info, Sign Up, Saving Card, Benefit Verification, Benefit Enrollments, Medical Exception, Injection Form, Share a Story

Form MVA Name:

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Download, Form, Link, Share, Tool, Video

Form MVA Tier:

Form MVA Category:

Savings Card, Insurance, Symptom Journal, Test Score Tracker, Condition Information, Doctor Discussion Guide, Dosing Information, Enrollment Form, Flashcard, Medical Exception, Patient Counseling Guide, Savings Card, Symptom Journal, Doctor Discussion Guide, Doctor Search, Dosage Calculator, Enroll, Med Reminders, Quick Poll, Resource Request, Symptom Quiz, UGC Submission, Contact Rep, Savings Card, Social Share, App Store, More Info, Patient Resources, Share Information, Share Results, Submit a Story, Assessment Tool, Benefits Verification, Carousel, Initiation, Myth versus Fact, Workaround Quiz, Formulary Tool, Image Expand, Medical Exception, Q And A, Slider, Administration Instructions, Condition Information, Insurance, Inventory, Mechanism of Action, Patient Story, Product Overview, Program Overview, Injection Training, Other

 

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