Savings Card Program for Saxenda® (liraglutide) injection 3 mg
Eligibility and Restrictions:
In order to redeem this offer, patient must have a valid prescription for the brand being filled. A valid Prescriber ID# is required on the prescription. Patient is not eligible if he/she participates in or seeks reimbursement or submits a claim for reimbursement to any federal or state health care program with prescription drug coverage, such as Medicaid, Medicare, Medigap, VA, DOD, TRICARE, or any similar federal or state health care program (each a Government Program), or where prohibited by law. This offer may not be redeemed for cash. By using this offer, you are certifying that you meet the eligibility criteria and will comply with the terms and conditions described herein and will not seek reimbursement for any benefit received through this card. Novo Nordisk’s Eligibility and Restrictions, and Offer Details may change from time to time, and for the most recent version, please visit this webpage. Re-confirmation of information may be requested periodically to ensure accuracy of data and compliance with terms. Patients with questions about the Savings Card offer may call 1-877-304-6895.
This offer is valid in the United States and may be redeemed at participating retail pharmacies. Absent a change in Massachusetts law, effective January 1, 2021, the Savings Card will no longer be valid for residents of Massachusetts. Void where taxed, restricted, or prohibited by law. This offer is not transferable and is limited to one offer per person. Not valid if reproduced.
Cash Discount Cards and other non-insurance plans are not valid as primary insurance under this offer. If the patient is eligible for drug benefits under any such program, the patient cannot use this offer. This Savings Card cannot be combined with any coupon, certificate, voucher, or similar offer.
Patient is responsible for complying with any insurance carrier co-payment disclosure requirements, including disclosing any savings received from this program. It is illegal to (or offer to) sell, purchase, or trade this offer.
This program is managed by ConnectiveRx on behalf of Novo Nordisk. The parties reserve the right to rescind, revoke or amend this offer without notice at any time.
Patients who are commercially insured may pay as little as (“PALA”) $25 per 30-day supply (1 box), $50 per 60-day supply (2 boxes), or $75 per 90-day supply (3 boxes) of Saxenda®. Subject to a maximum savings of $200 per 30-day supply (1 box) (“Savings Benefit”), $400 per 60-day supply (2 boxes), or $600 per 90-day supply (3 boxes) of Saxenda®. Cash-paying patients and commercially insured patients without drug coverage can save up to $200 per 30-day supply (1 box) (“Savings Benefit”), $400 per 60-day supply (2 boxes), or $600 per 90-day supply (3 boxes) of Saxenda®. Both offers are valid for up to 24 months from the date of Savings card activation and subject to a maximum of twelve 30-day prescriptions (12 boxes) per calendar year.
When you apply this offer, you are certifying that you have not submitted a claim for reimbursement under any Government Program for this prescription, or where prohibited by law. Participation in this program must comply with all applicable laws and regulations as a pharmacy provider. By participating in this program, you are certifying that you will comply with the eligibility criteria, and terms and conditions described herein. You also certify that you will not seek reimbursement for any benefit received through this card.
Pharmacist instructions for a patient with an Eligible Third Party:
Submit the claim to the primary Third Party Payer first, then submit the balance due to CHANGE HEALTHCARE as a Secondary Payer COB [coordination of benefits] with patient responsibility amount and a valid Other Coverage Code, (eg 8). The patient is responsible initially for the PALA amount and the card pays up to the Savings Benefit. Reimbursement will be received from CHANGE HEALTHCARE.
Pharmacist instructions for a cash-paying patient:
Submit this claim to CHANGE HEALTHCARE. A valid Other Coverage Code (eg, 1) is required. The patient pay amount submitted will be reduced by up to the Savings Benefit and reimbursement will be received from CHANGE HEALTHCARE.
For any questions regarding CHANGE HEALTHCARE online processing, please call the Help Desk at 1-800-433-4893.
Terms and Conditions of Use:
Please read these terms and conditions carefully. By texting “AGREE” back, you affirm that you are a US resident, 18 years of age or older, and expressly consent to receive non-marketing and marketing text messages from Novo Nordisk or its partners in connection with Novo Nordisk’s Rybelsus Connect Program (the “PROGRAM”). Your consent to receive marketing messages is not required for the receipt of goods or services from Novo Nordisk.
The PROGRAM’s Full Mobile Terms and Conditions of Use:
Express Consent. As stated above, by texting “AGREE” back, I affirm that I am a US resident, 18 years of age or older, and expressly consent to receive non-marketing and marketing text messages (SMS) and texts with images (MMS) from Novo Nordisk or its partners in connection with the PROGRAM. I understand that these messages may be made with an auto-dialer to my telephone number and that my consent to receive marketing text messages is not required for the receipt of goods or services from Novo Nordisk. These messages may be sent from any of these phone numbers:
The PROGRAM’s message frequency will vary. Please be aware that Novo Nordisk brands and services may have separate text messaging programs. The total number of text messages you receive from Novo Nordisk or its partners, therefore, may vary based on the number of Novo Nordisk text messaging programs for which you sign-up to receive messages.
You will not be charged any fee from Novo Nordisk or its partners in connection with the PROGRAM to receive non-marketing or marketing text messages. However, Novo Nordisk encourages you to check with your mobile service provider to see what other message and data rates may apply, including any applicable roaming charges.
Supported Carriers. The following US carriers are supported:
Major Carriers: AT&T, Verizon Wireless, Sprint, T-Mobile, MetroPCS, U.S. Cellular, Alltel, Boost Mobile, Nextel, and Virgin Mobile.
Minor Carriers: Alaska Communications Systems (ACS), Appalachian Wireless (EKN), Bluegrass Cellular, Cellular One of East Central IL (ECIT), Cellular One of Northeast Pennsylvania, Cincinnati Bell Wireless, Cricket, Coral Wireless (Mobi PCS), COX, Cross, Element Mobile (Flat Wireless), Epic Touch (Elkhart Telephone), GCI, Golden State, Hawkeye (Chat Mobility), Hawkeye (NW Missouri), Illinois Valley Cellular, Inland Cellular, iWireless (Iowa Wireless), Keystone Wireless (Immix Wireless/PC Man), Mosaic (Consolidated or CTC Telecom), Nex-Tech Wireless, NTelos, Panhandle Communications, Pioneer, Plateau (Texas RSA 3 Ltd), Revol, RINA, Simmetry (TMP Corporation), Thumb Cellular, Union Wireless, United Wireless, Viaero Wireless, and West Central (WCC or 5 Star Wireless).
Please know you may always opt-out of receiving text messages from Novo Nordisk or its partners related to the PROGRAM at any time by sending a reply text stating “STOP,” texting “STOP” to 68795 or visiting www.NovoCare.com/OptS.
However, please know that you will remain opted-in to other Novo Nordisk text and email messaging programs for which you have enrolled, if enrolled.
In addition to opting-out of the PROGRAM as set forth above, you may also choose to stop receiving all text messages related to the PROGRAM by visiting www.NovoCare.com/OptS and entering your cell phone number into the field provided there.
Please note that by opting-out via the website you will no longer receive any text messages from the PROGRAM. You will remain opted into other Novo Nordisk text or other email messaging programs for which you have enrolled.
Your Mobile Telephone Number:
You represent that you are the account holder for the mobile telephone number you opt-in to receive text messages for the PROGRAM.
To receive text messages or calls for the PROGRAM, you must be a resident of the US and 18 years of age or older. Novo Nordisk reserves the right to require you to prove that you are at least 18 years of age.
Access or Delivery to Mobile Network is Not Guaranteed:
Delivery of information and content to a mobile device is not guaranteed and may fail to due to a variety of circumstances or conditions. Alerts sent via text message may not be delivered if the mobile phone is not in range of a transmission site, or if sufficient network capacity is not available at a particular time. Even within a coverage area, factors beyond the control of the wireless carrier may interfere with message delivery, including the customer's equipment, terrain, proximity to buildings, foliage, and weather. Novo Nordisk will not be held responsible for any delays in the receipt of any text messages as delivery is subject to effective transmission from your mobile service provider or network operator. You understand and acknowledge that network services, including but not limited to mobile network services, are outside of Novo Nordisk’s control, and Novo Nordisk is not responsible or liable for issues arising from them.
Privacy & Security:
Since Novo Nordisk appreciates the value of your private personal health information, Novo Nordisk wants you to understand that it cannot guarantee the security of any personal health information transmitted via SMS text message. SMS text messages are not encrypted or protected. These communications and, possibly the content, may be stored on servers where mobile carrier employees, governments, or other unknown third parties might be able to view or access them.
Novo Nordisk understands and values the importance of your privacy. Please be aware that the data obtained from you in connection with this SMS message service may, among other things, include your cell phone number, carrier name, and message date, time, and content. We may use this information to contact you and to provide the services you request from us. In addition, your responses to any survey questions in this program will be combined with the responses from other participants in this program and shared with Novo Nordisk and its PROGRAM partners. However, the information shared with Novo Nordisk and its PROGRAM partners will not include your name, date of birth, or cell phone number or cell phone carrier. For more information on how we collect and use your information, please read our full Privacy Statement.
If you opt out (as explained above) from receiving PROGRAM text messages, any future data collection from you will end. You also understand that a significant portion of the PROGRAM is conducted via text messaging. These text messages may contain health information. Standard text messaging is not encrypted, and a third party could read these messages.
This program does not substitute medical advice from your health care provider. You will have to contact him or her directly about issues, questions, or concerns. (See NOT MEDICAL ADVICE below.) You further understand that this program is not a means to communicate product issues or negative side effects to Novo Nordisk. You are encouraged to report negative side effects of prescription drugs to the FDA at www.fda.gov/medwatch, or by phone at 1-800-FDA-1088. Novo Nordisk is not responsible for monitoring or recording text messages that may constitute an issue or negative side effect. However, if you are using a Novo Nordisk Product as treatment, and some of your entered responses can be interpreted as a side effect of the medication, Novo Nordisk reserves the right to contact you for more information by phone or written communication. For additional information about your medication, please call Novo Nordisk Customer Care at 1-833-693-6742.
NOT MEDICAL ADVICE:
The PROGRAM includes limited text message communications related to [co-pay/savings/affordability card] eligibility, enrollment, and refill reminders. OUR CONTENT AND COMMUNICATIONS ARE NOT INTENDED TO BE A REPLACEMENT OR SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. THE CONTENT AND COMMUNICATIONS DO NOT CONSTITUTE MEDICAL ADVICE, DIAGNOSIS, OR TREATMENT. YOU ACKNOWLEDGE AND UNDERSTAND THAT YOU WILL SEEK THE ADVICE OF A PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER WITH ANY QUESTIONS THAT ARISE REGARDING ANY MEDICAL CONDITION. YOU ACKNOWLEDGE THAT ALL INFORMATION AND GUIDANCE PROVIDED BY YOU IS SOLELY AT YOUR OWN RISK. You understand that Novo Nordisk does not endorse any particular physician or health care provider for the treatment of any specific medical condition.
Changes to Terms and Conditions of Use:
Termination of Text Messaging:
Novo Nordisk may suspend or terminate your receipt of Novo Nordisk text messages if Novo Nordisk believes you are in breach of these Mobile Terms and Conditions for SMS Messages. Your receipt of Novo Nordisk text messages is also subject to termination in the event that your mobile telephone service terminates or lapses. Novo Nordisk reserves the right to modify or discontinue, temporarily or permanently, all or any part of Novo Nordisk text messages, with or without notice. You assume sole responsibility for the proper use and scheduling of any medications, treatments, and procedures related to the patient's health care and disease management. Novo Nordisk assumes no responsibility for the accuracy or appropriateness of any information entered by you.