For opioid-induced constipation in adult patients with chronic non-cancer pain, including patients with chronic pain related to prior cancer or its treatment who do not require frequent (e.g., weekly) opioid dosage escalation
ELIGIBLE PATIENTS MAY PAY AS LITTLE AS $0* FOR EACH PRESCRIPTION
SYMPROIC PATIENT SAVINGS CARD
Commercially insured patients may be eligible to pay as little as $0*
- Co-pay amounts may vary—maximum savings is $150 per prescription
- Patients are responsible for any amount exceeding the maximum benefit of $150 on each prescription
- Patients whose prescriptions are covered under Medicare, Medicaid, or other government programs are not eligible
- Cash-paying patients are not eligible
*Maximum savings of $150 per prescription. Restrictions apply.
Please see Eligibility Requirements, and Terms and Conditions below.
For questions, call 844-SYMPROIC (844-796-7764)
This card cannot be used if your prescriptions are covered by: (i) any federal or state healthcare program, including a state medical or pharmaceutical assistance program (Medicare, Medicaid, Medigap, VA, DOD, TRICARE, etc); (ii) Medicare Prescription Drug Program (Part D Program); or (iii) insurance in states that have an “all payor” anti-kickback law or insurance that is paying the entire cost of the prescription. Void where prohibited by law. Patients must meet eligibility requirements. Other restrictions may apply. Cash-paying patients are not eligible.
TERMS AND CONDITIONS
Patients must meet eligibility requirements. Patient agrees to report their use of this card to any third party that reimburses or pays for any part of the prescription price. Patient additionally agrees to not submit any portion of the product dispensed pursuant to this card to a federal or state healthcare program for purposes of counting it toward their out-of-pocket expenses (such as TrOOP under Medicare Part D or Medicaid). This card is not valid with any other program, discount, or incentive involving the covered medication. This offer is good for 13 uses and can only be applied to prescriptions of 20 tablets or more. This offer is not contingent upon any past, present, or future purchases of the covered drug or any other product, and this offer may be rescinded, revoked, or amended without notice. No reproductions. This card is not insurance. This card is void where prohibited or where restricted beyond the terms herein.
INSTRUCTIONS FOR HEALTHCARE PROFESSIONALS
A valid prescription must accompany this card at time of first use. Tell your patients to retain their Symproic Savings Card for future savings during the time of offer throughout the program period. Treat these materials like you would a blank prescription pad. Hand them out yourself and don't leave them in the general waiting areas of your office.
The Symproic Savings Card is accepted at participating pharmacies. Certain pharmacies are able to deduct the savings without the Symproic Savings Card. For a list of these pharmacies, go to http://evoucherrx.relayhealth.com/storelookup/.
Please read the Full Prescribing Information. Also, please read the Eligibility Requirements, and Terms and Conditions above.
CoverMyMeds partners with electronic health records (EHRs), payers, pharmacies, and providers to initiate, transmit, and track the status of prior authorization (PA) requests within the clinical workflow.
CoverMyMeds technology electronically connects providers, pharmacists, and plan/pharmacy benefit managers (PBMs) to create an ePA solution for all participations.