WINLEVI® Co-Pay Program
Eligibility Rules and Terms and Conditions
To participate in the
- To participate in this Program, you must have commercial health insurance and be a resident of the United States, Puerto Rico, Guam, or the Virgin Islands.
- The following patients are ineligible for this Program.
- — Patients covered under Medicaid (including Medicaid patients enrolled in a Medicaid Managed Care Plan or a qualified health plan purchased through a health insurance exchange marketplace established by a state government or the federal government).
- — Patients covered by Medicare, a Medicare Part D or Medicare Advantage plan (regardless of whether a specific prescription is covered).
- — Patients covered by TRICARE, CHAMPUS, Puerto Rico Government Health Insurance Plan or any other state or federal medical or pharmaceutical benefit program or pharmaceutical assistance program.
- — Patients with no insurance.
Terms and Conditions
- You agree to not to seek any reimbursement for all or any part of the co-pay assistance received through the Program. By using this card, you are certifying that you understand the Eligibility Rules and Terms and Conditions, that you have responded truthfully to questions when activating the card, and that you will disclose and report, your receipt of any Program benefits to your insurer, health plan, or any third party that pays or reimburses you for the cost of medications, if required.
- This offer may be rescinded, revoked or cancelled at any time, without further notice and the rules may be amended at any time, without further notice.
- This Program is not insurance.
- The Program is void where prohibited by law, taxed, or restricted. Any benefit provided is not transferable and cannot be combined with any other program, free trial, discount, prescription savings card, or other offer. No purchase, other than for a WINLEVI prescription is required to participate.
- Personal data that you provide to the Program may be collected, analyzed, and shared with the program sponsor for market research and other lawful purposes but only in aggregated and de-identified form.