Terms and Conditions:
- This offer is valid for eligible commercially insured patients and is good for use only with a ZOLGENSMA® (onasemnogene abeparvovec-xioi) prescription at the time the prescription is filled or after the product is administered to the patient.
- Depending on commercial insurance coverage, eligible patients may utilize this benefit to cover deductibles, co-pay, and co-insurance amounts associated with the ZOLGENSMA product, up to a certain maximum benefit. Call the program and/or check with the health care provider to verify co-pay assistance benefit. Patient out-of-pocket expenses may vary.
- This offer is not valid for patients enrolled in Medicare, Medicaid, or other federal or state health care programs, or private indemnity or HMO insurance plans that reimburse you for the entire cost of your prescription drugs. Patients may not use this benefit if they are Medicare-eligible and enrolled in an employer-sponsored health plan or medical or prescription drug benefit program for retirees.
- The offer is valid for 1 year. An explanation of benefits statement must be faxed in to the program prior in order for the benefit to become eligible for billing.
- Novartis Gene Therapies reserves the right to rescind, revoke, or amend this offer without notice.
- Offer good only in the USA at participating Specialty Pharmacies and healthcare providers.
- Void if prohibited by law, taxed, or restricted.
- This benefit is not transferable. The selling, purchasing, trading, or counterfeiting of this benefit and/or co-pay card is prohibited by law.
- This benefit is not insurance.
By redeeming this benefit, you acknowledge that you are an eligible patient and that you understand and agree to comply with the terms and conditions of this offer.