*Terms and Conditions:
*By using the Olumiant Savings Card (“Card”), you attest that you meet the eligibility criteria, agree to and will comply with the terms and conditions described below:
Offer good until 12/31/2024 or up to 36 months of therapy from patient qualification into the program, whichever comes first. Patients must first use their card by 12/31/2021. Patients must have coverage for Olumiant through their commercial drug insurance to pay as little as $5 for a 30-day supply of Olumiant. Offer subject to a monthly cap of wholesale acquisition cost plus usual and customary pharmacy charges and a separate annual cap set at Lilly’s sole discretion. Patients must have commercial drug insurance and prescription consistent with FDA-approved product labeling to pay as little as $25 for a 30-day supply of Olumiant. Offer subject to a monthly cap of wholesale acquisition cost plus usual and customary pharmacy charges and a separate annual cap of wholesale acquisition cost plus usual and customary pharmacy charges. Participation in the $25 program requires submission of a prior authorization (PA). If coverage is denied, an appeal must be submitted prior to the 5th month fill. A new PA and appeal or medical exception (ME) must be submitted every 12 months or as required by Lilly to verify coverage status and potential eligibility for the $5 program. Participation in the program requires a valid patient HIPAA authorization.
Offer void where prohibited by law. Patient is responsible for any applicable taxes, fees, or amounts exceeding monthly or annual caps. This offer is invalid for patients without commercial drug insurance or whose prescription claims for Olumiant are eligible to be reimbursed, in whole or in part, by any governmental program, including, without limitation, Medicaid, Medicare, Medicare Part D, Medigap, DoD, VA, TRICARE®/CHAMPUS, or any state patient or pharmaceutical assistance program. This offer is not valid for: Massachusetts residents if an AB-rated generic equivalent is available; California residents if an FDA-approved therapeutic equivalent is available. Available only in the US and Puerto Rico for residents of the US and Puerto Rico. By accepting this offer, you agree that if you are required to do so under the terms of your insurance coverage for this prescription or are otherwise required to do so by law, you should notify your insurance carrier of your redemption of this Card. This offer cannot be combined or utilized with any other program, discount, discount card, cash discount card, coupon, incentive, or similar offer involving Olumiant. It is prohibited for any person to sell, purchase or trade; or to offer to sell, purchase or trade, or to counterfeit this Card. This offer may be terminated, rescinded, revoked, or amended by Lilly USA, LLC at any time without notice. Card activation required. This Card is not health insurance. This Card expires on 12/31/2024. Upon offer expiration, at Lilly’s sole discretion you may be eligible to re-enroll by activating a new offer.
