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