QULIPTA LIST PRICE
The Wholesale Acquisition Cost (WAC), also known as the list price, for a 30-day supply of QULIPTA is $1,040.55 as of January 2023. The WAC may not reflect the price paid by patients.
Because coverage varies by plan, call your insurance company to understand your QULIPTA coverage.
INSURANCE INFORMATION*
Eligible commercially insured patients may pay as little as $0 for their prescription
with the QULIPTA® Complete Savings Card.†
Learn about the QULIPTA Complete Savings Card ›
If you have…You could pay…
Medicaid Reasons why your monthly cost may differ:
Household income could play a role in determining your monthly cost Out-of-pocket charges vary from state to state
Contact your prescription coverage provider (commonly referred to as Pharmacy Benefit manager) to learn more.
Medicare Part D Reasons why your monthly cost may differ:
A lack of supplemental coverage (Part D) The benefit varies during different coverage phases of most Part D plans Not all Part D plans are the same, and they may have different rules and benefits
Contact your prescription coverage provider (commonly referred to as pharmacy benefit manager) to learn more.
Medicare Low Income Subsidy (LIS) Depending on your eligibility, your may pay $10.35 for a 30-day supply.
Other Insurance (VA, DOD, TRICARE, Others) Because coverage varies by plan, call your insurance company to understand your QULIPTA coverage.
Uninsured or if you cannot afford your medication If you are having difficulty paying for your medicine, AbbVie may be able to help. Visit AbbVie.com/myAbbVieAssist to learn more.
Medicaid
Reasons why your monthly cost may differ:
• Household income could play a role in determining your monthly cost
• Out-of-pocket charges vary from state to state
Contact your prescription coverage provider (commonly referred to as pharmacy benefit manager) to learn more.
Medicare Part D
Reasons why your monthly cost may differ:
• A lack of supplemental coverage (Part D)
• The benefit varies during different coverage phases of most Part D plans
• Not all Part D plans are the same, and they may have different rules and benefits
Contact your prescription coverage provider (commonly referred to as pharmacy benefit manager) to learn more.
Medicare Low Income Subsidy (LIS)
Depending on your eligibility, your may pay $10.35 for a 30-day supply.
Other Insurance (VA, DOD, TRICARE, Others)
Because coverage varies by plan, call your insurance company to understand your QULIPTA coverage.
Uninsured or if you cannot afford your medication
If you are having difficulty paying for your medicine, AbbVie may be able to help. Visit AbbVie.com/myAbbVieAssist to learn more.
*Important details about understanding your individual costs:
The chart above provides cost information based on what a person with the type of coverage listed may pay for. Your type of health or prescription insurance plan will determine exactly how much you will pay. Information listed is accurate as of January 2023 and is based on publicly available benefit design information for Medicaid and Medicare Part D out-of-pocket costs for the 2023 plan year.
INSURANCE COVERAGE
SUPPORT
To help you understand your coverage and what your out-of-pocket costs may be, it’s important to verify your benefits.
Because coverage varies by plan, call your insurance company to understand your QULIPTA coverage.
SAVINGS & SUPPORT
MADE SIMPLE
The QULIPTA Complete Savings Card may make prescriptions cost as little as $0 a month† for eligible commercially insured patients.
myAbbVie Assist
If you are having difficulty paying for your medicine, myAbbVie Assist may be able to help.
myAbbVie Assist, our patient assistance program, provides AbbVie medicine to qualifying patients. It is intended for people that live in the United States, have limited or no health insurance coverage and demonstrate qualifying financial need.
Visit AbbVie.com/myAbbVieAssist to learn more.
†Terms and Conditions apply. This benefit covers QULIPTA® (atogepant). Eligibility: Available to patients with commercial insurance coverage for QULIPTA who meet eligibility criteria. Co-pay assistance program is not available to cash paying patients or patients receiving 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 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 patient must call 1-855-QULIPTA to stop participation. Patients residing in or receiving treatment in certain states may not be eligible. Patients may not seek reimbursement for value received from the QULIPTA Complete Savings Card from any third-party payers. Offer subject to change or discontinuation without notice. Restrictions, including monthly maximums, may apply. Subject to all other terms and conditions, the maximum annual benefit that may be available solely for the patient’s benefit under the co-pay assistance program where coverage is available is $6,000 per calendar year. Patients may be eligible to receive up to 12 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 2 30-day fills at no charge for an FDA-approved indication while coverage is pending. The actual application and use of the benefit available under the co-pay assistance program may vary on a monthly, quarterly, and/or annual basis, depending on each individual patient’s plan of insurance and other prescription drug costs. 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 https://privacy.abbvie.
To Pharmacists: For further information, please contact 800-364-4767.