TRYVIO Patient Support Terms & Conditions
FREE TRIAL TERMS AND CONDITIONS
This offer is not contingent on a purchase of any kind. The free trial may be redeemed for a single, one-time-only, 30-day supply (maximum 30 tablets) of TRYVIO. Patients must be new to TRYVIO and must not have previously filled a prescription for TRYVIO. A patient must be under the care of a licensed US physician that has been REMS certified. Patients must have a valid prescription(s) for TRYVIO. This offer may be used by cash-paying patients, patients with commercial insurance, and patients who are eligible for or participate in federal healthcare programs such as Medicaid, Medicare, or any similar federal or state programs only when patients, pharmacists, and prescribers agree not to seek reimbursement from health insurance, health savings or flexible spending accounts, or any third party, including state or federally funded programs for the free trial of TRYVIO received by the patient through this offer. Patients eligible for the free trial may not count the free trial as an expense incurred for determining out-of-pocket costs for any plan, including true out-of-pocket costs (“TrOOP”), under Medicare Part D. This offer is limited to one per patient and is nontransferable. This free trial offer cannot be combined with any other free trial, coupon, discount, prescription savings card or other offer. No substitutions are permitted. This offer is not health insurance, nor is it provided for the purpose of financial assistance. This offer is restricted to residents of the United States. Void where prohibited by law, taxed or restricted. Not valid in California or Massachusetts, if an AB-rated generic equivalent becomes available for the product. This offer may be changed or discontinued at any time without notice. Patients are responsible for applicable taxes, if any. By redeeming this free trial voucher, you acknowledge that you are an eligible patient and that you understand and agree to comply with the terms and conditions of this offer.
TRYVIO SAVINGS CARD TERMS OF USE AND RESTRICTIONS
Eligibility Requirements: Patients may be eligible if: (1) the patient is insured by commercial insurance and their prescription insurance coverage does not cover the full cost of the prescription; (2) patient does not have prescription insurance coverages through a state or federal healthcare program, including but not limited to Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), or Department of Defense (DOD) programs; patients who move from commercial insurance plans to state or federal healthcare programs will no longer be eligible; (3) patient is 18 years of age or older; (4) patient is a resident of the United States.
Terms of Use: Eligible commercially insured patients with a valid prescription for TRYVIO (aprocitentan) 12.5 mg who present this savings card at participating pharmacies may pay as little as $10 for a 30-day supply. Maximum savings limit applies; patient out-of-pocket expenses may vary. The patient is responsible for applicable taxes—void where prohibited by law, taxed, or restricted. Other restrictions may apply. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer. All copay payments are for the benefit of the patient only. Idorsia reserves the right to rescind, revoke, or amend this offer, eligibility, and terms of use at any time without notice. Must present offer along with a valid prescription at the time of purchase.
Restrictions: This offer is not valid for cash-paying patients. This offer is nontransferable, no substitutions are permissible, and the offer cannot be applied with any other financial assistance program, free trial, discount, prescription savings card, or other offers. The savings card for TRYVIO is not health insurance. The savings card may not be sold, purchased, or traded. ConnectiveRx manages this program on behalf of Idorsia.
For Healthcare Professionals Only: Pharmacist Instructions for a Patient with an Eligible Third Party: For Insured/Covered Patients: Submit the claim to the primary Third-Party Payer first, then submit the balance due to SS&C as a Secondary Payer COB with patient responsibility amount and a valid Other Coverage Code of 08. Patient pays $10 for a 30-day supply. The pharmacist will receive reimbursement from SS&C.
For any questions regarding SS&C online processing, please call the Help Desk at 844-373-0987.