Eligibility For Your Patients

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*By activating the co-pay card, your patient agrees to the following statements:

  • Your patient’s information above is true and correct
  • Your patient is not enrolled in a federal- or state-funded prescription drug benefit program, such as Medicare or Medicaid, or any private indemnity or HMO insurance that reimburses your patient the entire cost of your prescription drug
  • You agree that your patient is not Medicare-eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees
  • Should your patient begin receiving prescription benefits from one of these types of programs at any time, your patient will no longer participate in this savings program.
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Co-pay Savings Program for Kyleena TERMS & CONDITIONS

  • Patient must meet the eligibility requirements of the Co-pay Savings Program for Kyleena; for example, only commercially insured patients are eligible
  • Patient must inform the Co-pay Savings Program for Kyleena of change in insurance status
  • It is required that the patient understand, accept, and meet the terms of all the Co-pay Savings Program for Kyleena requirements
  • Use of the Co-pay Savings Program for Kyleena must be consistent with and not prohibited by the requirements of the patient’s health insurance
  • The Co-pay Savings Program for Kyleena benefit has a max of $950, per patient
  • The Co-pay Savings Program for Kyleena is for commercially insured patients using Kyleena for an approved FDA indication
  • The Co-pay Savings Program for Kyleena does not cover costs for charges associated with patient visits
  • Offer valid only for patients treated in the USA, including Puerto Rico, Guam and US Territories
  • Bayer reserves the right to determine eligibility, monitor participation, equitably distribute product and modify or discontinue the Co-pay Savings Program for Kyleena at any time with or without notice
  • Patient agrees to provide necessary health information to the administrators of the Co-pay Savings Program for Kyleena

For questions about the Co-pay Savings Program for Kyleena, please call us at 1-833-244-2719.