By participating in the 14-Day Free Trial, the patient acknowledges and agrees that he/she is eligible to participate and that he/she understands and agrees to comply with the General and 14-Day Free Trial Terms and Conditions.Ĭopay Assistance Terms and Conditions: Eligible patients must present their activated card to the pharmacist along with their valid Onfi prescription to participate in this program. Patient questions and requests to discontinue participation in the programs can be directed to 1-85 (8:00 am-8:00 pm ET, Monday through Friday).ġ4-Day Free Trial Terms and Conditions: To participate in this program, eligible commercially insured patients age 2 and older must present the 14-day free trial voucher to the pharmacist along with their valid prescription. There is no future purchase requirement associated with the Offers. Offers are valid only in the USA where allowed by law. Offers are intended to comply with all applicable laws and regulations, including, without limitation, the federal Anti-Kickback Statute, its implementing regulations, and related guidance interpreting the federal Anti-Kickback Statute. Lundbeck reserves the right to rescind, revoke, or amend the Offers without notice. The Offers have no cash value and may not be used in combination with any other discount, coupon, rebate, free trial, or similar offer for the specified prescription. The selling, purchasing, trading, or counterfeiting of the Offers is prohibited by law. ![]() Patients are responsible for complying with any obligations or requirements imposed by their insurance plans. The free trial and copay prescriptions shall not be submitted for reimbursement to any public third-party payer, including Medicaid or Medicare or any other similar federal or state healthcare program in addition, the free trial prescription shall not be submitted to any private third-party payer. Offers apply only to prescriptions filled before the programs expire. Offers are valid only for use with a valid prescription for ONFI at the time the prescription is filled by the pharmacist and dispensed to the patient. In addition, patients may not use the Offers if they are Medicare-eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees. Patients are not eligible for the Offers if they are self-pay or if the prescription is eligible to be reimbursed, in whole or in part, by any state or federal health care programs, including but not limited to Medicare or Medicaid, Medigap, VA, DOD, or TRICARE. General Terms and Conditions: Only commercially insured patients age 2 and older whose insurance policy provides coverage for ONFI ® (clobazam) and who are not reimbursed for the entire cost of the prescription are eligible for the 14-day free trial voucher or copay assistance (the “Offers”). Terms and Conditions for the ONFI 14-Day Free Trial and Copay Assistance Programs
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