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. 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. Restrictions, including monthly maximums, may apply. Offer subject to change or discontinuation without notice. Patients may not seek reimbursement for value received from the QULIPTA Complete Savings Card from any third-party payers. Patients residing in or receiving treatment in certain states may not be eligible. 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. 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, 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. Eligibility: Available to patients with commercial insurance coverage for QULIPTA who meet eligibility criteria. This benefit covers QULIPTA® (atogepant). If you are having difficulty paying for your medicine, AbbVie may be able to help. Uninsured or if you cannot afford your medication Other Insurance (VA, DOD, TRICARE, Others)īecause coverage varies by plan, call your insurance company to understand your QULIPTA coverage. Not all Part D plans are the same, and they may have different rules and benefitsĭepending on your eligibility, your may pay $10.35 for a 30-day supply.The benefit varies during different coverage phases of most Part D plans.A lack of supplemental coverage (Part D).Out-of-pocket charges vary from state to state.Household income could play a role in determining your monthly cost.Reasons why your monthly cost may differ: Uninsured or if you cannot afford your medication If you are having difficulty paying for your medicine, AbbVie may be able to help. Other Insurance (VA, DOD, TRICARE, Others) Because coverage varies by plan, call your insurance company to understand your QULIPTA coverage. Medicare Low Income Subsidy (LIS) Depending on your eligibility, your may pay $10.35 for a 30-day supply. Medicare Part D Reasons why your monthly cost may differ:Ī 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 benefitsĬontact your prescription coverage provider (commonly referred to as pharmacy benefit manager) to learn more. Household income could play a role in determining your monthly cost Out-of-pocket charges vary from state to stateĬontact your prescription coverage provider (commonly referred to as Pharmacy Benefit manager) to learn more. Medicaid Reasons why your monthly cost may differ:

Va copay income limits