*For US patients only. While supplies last. INTRAROSA should be stored at 41°F to 86°F (5°C to 30°C).
It can bet
stored at room temperature or in the refrigerator. To avoid higher temperatures that could cause
INTRAROSA to melt,
don’t store INTRAROSA in areas like a hot car, a sunny window sill, or directly near a heater.
†By submitting this form, you are certifying that you are a US resident over the age of 18 and agree
emails from AMAG Pharmaceuticals.
SAVINGS CARD TERMS AND CONDITIONS
Eligible commercially insured patients pay no more than $35 copay for each 28-day supply of INTRAROSA
for up to 12
months. Limitations apply. Each copay card may be used once every 28 days for up to 12 uses or program
whichever occurs first. A valid prescriber ID# is required on the prescription. Any remaining
will be the patient’s responsibility.
Patient Instructions: In order to redeem this offer, you must have a valid
INTRAROSA. Follow the dosage instructions given by the doctor. This offer may not be redeemed for cash
and is not
insurance. By using this offer, you are certifying that you meet the eligibility criteria and will
comply with the
terms and conditions described in the Restrictions section below. Patients with questions about the
offer should call 1-844-492-9898.
Pharmacist: When you apply this offer, you are certifying that you have not submitted
a claim for
reimbursement under any federal, state, or other governmental programs for this prescription.
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 terms and conditions described in the Restrictions
Pharmacist Instructions for a Patient With an Eligible Third-Party Payer: Submit the claim to
the primary Third-Party
Payer first, then submit the balance due to Argus as a Secondary Payer as a copay
using BIN# 019158 and a
valid Other Coverage Code (eg, 8). Eligible commercially insured patients pay no more than $35 copay
for each 28-day
supply of INTRAROSA for up to 12 months. Limitations apply. Reimbursement will be received
from Argus . Valid Other
Coverage Code required. For any questions regarding Argus online processing, please
call the Help
Restrictions: This offer is valid in the United States and Puerto Rico for
commercially insured patients 18 years of
age or older. Offer not valid for prescriptions reimbursed under Medicaid, Medicare, TRICARE, VA, DOD,
federal or state health programs (such as medical assistance programs). If the patient is eligible for
under any such program, the patient cannot use this offer. By using this offer, the patient certifies
that he or she
will comply with any terms of his or her health insurance contract requiring notification to his or
her payer of the
existence and/or value of this offer. It is illegal to (or offer to) sell, purchase, or trade this
offer. Program expires 12/31/2019. This offer is not transferable and is limited to one offer per person. Not valid
Void where prohibited by law. Program managed by ConnectiveRx on behalf of AMAG Pharmaceuticals, Inc.
reserve the right to rescind, revoke, or amend this offer without notice at any time.