- This offer is available to patients with commercial prescription drug insurance coverage for a valid prescription for lo loestrin® fe (ethinyl estradiol norethindrone acetate tablets, ethinyl estradiol tablets, and ferrous fumarate tablets) at the time in which the prescription is filled by the pharmacist and dispensed to the patient.
- This offer is not valid for use by patients enrolled in medicare, medicaid or other federal or state programs (including state pharmaceutical assistance programs), or private indemnity insurance plans or hmo’s that reimburse you for the full cost of your prescription drugs, or where prohibited by law or by the patient’s health insurance provider. patients cannot use this offer if they are eligible for medicare and enrolled in an employer-sponsored health plan or retiree prescription drug benefit program. This offer is not valid for patients paying cash. If at any time a patient begins receiving prescription drug coverage under any federal, state, or government-funded health care program, the patient will no longer be eligible to use the loestrin fe savings program.
- Depending on your insurance coverage, eligible patients can pay as little as $25 for each of up to thirteen (13) one-month fills of prescriptions or each of up to four (4) three-month fills of prescriptions. check with your pharmacist for your copay discount. maximum savings limits apply; patient out-of-pocket costs will vary.
- Each card is good for up to thirteen (13) prescriptions for a 28-day supply each or up to four (4) prescriptions for an 84-day supply each. offer applies only to prescriptions filled before program expires on 12/31/22.
- abbvie reserves the right to terminate, revoke, or modify this offer without notice.
- offer valid in the us only. USA, including Puerto Rico, at participating retail pharmacies. patients residing or receiving treatment in certain states may not be eligible.
- void where prohibited by law, taxed or restricted.
- Patients may not request reimbursement for the value received from the loestrin fe savings program from third-party payers.
- This card is not transferable. The law prohibits the sale, purchase, exchange or counterfeiting of this card.
- This card has no cash value and cannot be used in conjunction with any other discount, coupon, rebate, free trial, or similar offer for the specified prescription.
- This offer is not health insurance.
- This card expires on December 31, 2022.
- By redeeming this card, you acknowledge that you are an eligible patient and that you understand and agree to abide by the terms and conditions of this offer.
If you are a patient and have questions about the program, including savings on mail-order prescriptions, please call 1.855.439.2817.
Pharmacist instructions for a patient with an eligible third party payer:
When you redeem this card, you certify that you have not filed and will not file a claim for reimbursement under any federal, state, or other government program for this prescription. submit the claim to the third party primary payer first, then submit balance due to change of care using container #004682 as secondary payer cob with patient responsibility amount and a valid other coverage code (eg. , 8). If you receive a denial due to pa, step-edit, or ndc block, please submit another coverage code of 03 (secondary claim). the patient’s out-of-pocket expense will be reduced up to the maximum savings limit for the program. reimbursement will be received from change of medical care. If you have any questions about online care change processing, please call the savings program navigator at 1.800.769.3161.
program administered by connectiverx on behalf of abbvie.