Offer good for up to 36 months from patient qualification into the program or until 12/31/2023, whichever comes first, provided patient continues to meet program terms and conditions. Patients must first use their card by 12/31/2020. Patient must have coverage for Taltz with their commercial drug insurance to pay as little as $5 monthly for a 28-day supply of Taltz, subject to a monthly cap of wholesale acquisition cost plus usual and customary pharmacy charges and a separate $16,000 maximum annual cap. Patient must have commercial drug insurance and a prescription consistent with FDA approved product labeling to pay as little as $25 monthly for a 28-day supply of Taltz, subject to a monthly cap of wholesale acquisition cost plus usual and customary pharmacy charges. Continued participation in the $25 program requires submission of a prior authorization (PA) before the 2nd month fill and, if coverage is denied, an appeal must be submitted prior to 5th month fill. A new PA and appeal or medical exception (ME) must be submitted every 12 months to verify coverage status and potential eligibility for the $5 program. Participation in the program requires a valid patient HIPAA authorization. Patient is responsible for any applicable taxes, fees, or amounts exceeding monthly or annual caps. This offer is invalid for patients without commercial drug insurance or those whose prescription claims are eligible to be reimbursed, in whole or in part, by any governmental program, including, without limitation, Medicaid, Medicare, Medicare Part D, Medigap, DoD, VA, TRICARE®/CHAMPUS, or any state patient or pharmaceutical assistance program. Offer void where prohibited by law and subject to change or discontinue without notice. Card activation is required. Subject to additional terms and conditions, which can be found here.
