Olumiant Savings Card - Non-covered benefit

Funded

About

The Olumiant Savings Card - Non-covered benefit program provides valuable financial assistance to patients prescribed Olumiant for an FDA-approved indication. Eligible participants may enjoy savings of up to $25 on a 30-day supply, significantly reducing out-of-pocket expenses. Designed for privately insured patients residing in the US and Puerto Rico, the Olumiant Savings Card enhances accessibility to this important medication.

Insurance requirements: Commercially insured, Underinsured

As low as: $25 per mo

Enrollment Forms

Enrollment Form

Benefits

•13 maximum fills per year

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Must be 18 years of age or older

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: No

•Activation Required: Yes

Program Details

•Eligible commercially insured/not covered patients may be able to pay as little as $25 for each 30day supply

•Participation in the $25 program requires submission of a PA prior to the first prescription fill

•If coverage is denied, an appeal must be submitted prior to 5th month prescription fill; to remain eligible for the Program, a new PA, appeal, or medical exception must be submitted prior to the 13th prescription fill

•Card may be used for up to a maximum of 13 prescription fills per calendar year and up to a maximum of 24 prescription fills over the lifetime of the Program, subject to a maximum monthly and annual savings limit

Enrollment Forms

Enrollment Form

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Other Tools for Olumiant

Get prior authorization forms