Terms and Conditions apply. This benefit covers SYNTHROID® (levothyroxine sodium). Eligibility: Available only to patients with commercial insurance coverage for SYNTHROID who meet eligibility criteria. The form of co-pay assistance, enrollment requirements, and processes may vary, please call 1-866-627-4980 for additional information. Co-pay assistance program is not available to patients receiving reimbursement under any federal, state, or government-funded insurance programs (for example, Medicare [including Part D], 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. If you live or receive treatment in certain states, you may not be eligible. If at any time a patient begins receiving drug coverage under any such federal, state, or government-funded healthcare program, patient will no longer be able to use the SYNTHROID Co-pay Savings Card and patient must call 1-866-627-4980 to stop participation. Co-pay assistance provided under this program is offered to and intended for the sole benefit of eligible patients and may not be transferred to or utilized for the benefit of third parties, including, without limitation, third-party insurance plans and/or pharmacy benefit managers and their agents. Patients may not seek reimbursement for value received from the SYNTHROID Co-pay Savings Program from any third-party payers, including insurance plans, flexible spending plans or health savings accounts. Co-pay support made available under this program may not be used with any other coupon, discount, prescription savings card, free trial, or other offer (including any program offered by a third-party insurance plan or pharmacy benefit manager, or an agent of either, that adjusts patient cost-sharing obligations). This is not health insurance. Offer subject to change or discontinuation without notice. Restrictions, including monthly maximums, may apply. Subject to all other terms and conditions, the maximum monthly benefit that may be available solely for the patient’s benefit under the co-pay assistance program is $15.00 per month during the calendar year for patients receiving SYNTHROID every month or $25.00 per month during the calendar year for patients receiving SYNTHROID every 3 months. Patients without health insurance may pay a fixed cash price of $39.95 for a 1-month prescription or $99.90 for a 3-month prescription. The actual application and use of the benefit available under the co-pay assistance program may vary on a monthly, quarterly, and/or annual basis, depending on each individual patient’s plan of insurance and other prescription drug costs. By utilizing this co-pay assistance program, you hereby accept and agree to abide by these terms and conditions. Any individual or entity who enrolls or assists in the enrollment of a patient in the co-pay assistance program represents that the patient meets the eligibility criteria and other requirements described herein. Further, you agree that you currently meet the eligibility criteria and other requirements described herein every time you use the co-pay assistance program. To learn about AbbVie’s privacy practices and your privacy choices, visit https://abbv.ie/corpprivacy.
