SAVINGS CARD
for as little as
$0
A Month
LET’S GET YOU STARTED with
savings & Support
Take advantage of personalized support and savings with the QULIPTA Patient Savings Program.
Fill out the information below and submit to enroll.
Once enrolled, here’s what you can expect:
quick, affordable access to Qulipta
Eligible commercially insured patients pay as little as $0 a month. If you experience an insurance delay or denial, eligible patients can receive QULIPTA shipped directly to their door*
quick, affordable access to Qulipta
Eligible commercially insured patients pay as little as $0 a month. If you experience an insurance delay or denial, eligible patients can receive QULIPTA shipped directly to their door*
quick, affordable access to Qulipta
Eligible commercially insured patients pay as little as $0 a month. If you experience an insurance delay or denial, eligible patients can receive QULIPTA shipped directly to their door*
Questions? Support is only a phone call away. Call 1-855-QULIPTA (1-855-XXXXX) Monday through Friday, 8AM-8PM ET
*Terms and Conditions apply. This benefit covers QULIPTA. Eligibility: Available to patients with commercial prescription insurance coverage for QULIPTA who meet eligibility criteria. Copay assistance program is not available to patients receiving prescription reimbursement under any federal, state, or government-funded insurance programs (for example, Medicare [including Part D], Medicare Advantage, Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs programs) or where prohibited by law or by the patient’s health insurance provider. If at any time a patient begins receiving prescription drug coverage under any such federal, state, or government-funded healthcare program, patient will no longer be able to use the QULIPTA Patient Savings Program Card and patient must call QULIPTA at 1-800-QULIPTA and stop use of the copay card. Patients residing in or receiving treatment in certain states may not be eligible. Patients may not seek reimbursement for value received from QULIPTA Patient Savings Program, including the copay card, from any third-party payers. Offer subject to change or discontinuance without notice. Restrictions, including monthly maximums, may apply. This is not health insurance.
Sign up for a QULIPTA Complete Savings Card to save
every time you go to the pharmacy for QULIPTA
Two steps to savings:
Save your card to your phone, then show it to the pharmacist when you pick up your prescription
You can save the card to your mobile wallet so you always have it handy when you pick up your prescription.
*Eligibility: Available to patients with commercial insurance coverage for QULIPTA® (atogepant) who meet eligibility criteria. This co-pay assistance program is not available to patients receiving prescription reimbursement under any federal, state, or government-funded insurance programs (for example, Medicare [including Part D], Medicare Advantage, Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs programs), or where prohibited by law. Offer subject to change or termination without notice. Restrictions, including monthly maximums, may apply. This is not health insurance. For full Terms and Conditions, visit QULIPTASavingsCard.com or call 1-855-QULIPTA for additional information. To learn about AbbVie’s privacy practices and your privacy choices, visit https://abbv.ie/corpprivacy.
QULIPTA COMPLETE OFFERS:
Savings on QULIPTA
for eligible commercially
insured patients
Help with
insurance questions
Treatment tools
like symptom trackers
and refill reminders
LOST YOUR SAVINGS CARD?
TEXT‡ SAVE TO 785478 AND WE
WILL RESEND.
If you have additional questions, you can call 1-855-QULIPTA (1-855-785-4782).
If you’ve already paid out of pocket for QULIPTA and would like to request reimbursement, visit Complete Rebate.
†PROGRAM TERMS AND CONDITIONS:
1. This offer is valid only for patients 18 years of age or older and is good for use only with a valid prescription for QULIPTA® (atogepant) tablets at the time the prescription is filled by the pharmacist and dispensed to the patient. 2. This offer is not valid for use by patients enrolled in Medicare, Medicaid, or other federal or state programs (including any state pharmaceutical assistance programs) or private indemnity or HMO insurance plans that reimburse you for the entire cost of your prescription drugs. If at any time, a participating patient begins receiving prescription drug coverage under any federal, state, or government-funded healthcare program, the patient will no longer be eligible for the Qulipta Complete Savings Card and must cease participation. This offer is not valid for cash-paying patients. 3. Eligible commercially insured patients may pay as little as $0 per monthly prescription fill. Patient out-of-pocket expense will vary; check with your pharmacist for your co-pay discount. Restrictions, including monthly, quarterly, and/or annual maximums, may apply. 4. Subject to all other terms and conditions, a commercially insured patient whose plan covers QULIPTA may receive up to a maximum annual benefit of $7,000 per calendar year, solely for the patient’s benefit, when using the Qulipta Complete Savings Card. Commercially-insured patients for whom coverage is not available because the insurer has not established a coverage review process may be eligible to receive up to 2 one-month fills at no charge for an FDA-approved indication. Under this program, once an insurer has established a review process for coverage requests, commercially insured patients may receive up to a maximum of 2 one-month fills at no charge for an FDA-approved indication while coverage is pending. 5. Patients may not seek reimbursement for value received from the Qulipta Complete Savings Card from any third-party payers. 6. AbbVie reserves the right to rescind, revoke, or amend this offer without notice. 7. Offer good only in the USA, including Puerto Rico, at participating retail pharmacies. Patients residing in or receiving treatment in certain states may not be eligible to participate in this program. 8. Void if prohibited by law, taxed, or restricted. 9. This card is not transferable. The selling, purchasing, trading, or counterfeiting of this card is prohibited by law. 10. This card has no cash value and may not be used in combination with any other discount, coupon, rebate, free trial, or similar offer for the specified prescription. 11. This offer is not health insurance. 12. By redeeming this offer, you acknowledge that you are an eligible commercially-insured patient and that you understand and agree to comply with the above terms and conditions.
For questions about the program, including savings on mail-order prescriptions, or to activate your card ID, please call 1-855-QULIPTA (1.855.785.4782).
To learn about AbbVie’s privacy practices and your privacy choices, visit https://abbv.ie/corpprivacy.
‡Msg and data rates apply. Msg frequency depends on user. Reply HELP for help; reply STOP to cancel. Consent to texts not required to sign up for offer.
To Pharmacists: For further information, please contact 1-800-364-4767.