Qulipta Complete Savings Card - Covered benefit

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About

The Qulipta Complete Savings Card - Covered benefit is designed to help patients access the drug Qulipta at reduced costs. By enrolling in the Qulipta Complete Savings Card program, eligible patients with private insurance can significantly lower their copayments, potentially paying as little as $0 monthly. This program provides a valuable benefit for those prescribed Qulipta, ensuring affordability and accessibility, while excluding those covered by government-funded programs or residing in certain states.

Insurance requirements: Commercially insured

Enrollment Forms

Enrollment Form

Benefits

•$7000 annual maximum benefit

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Enrollment Required: Yes

•Coverage Required: Yes

•Needs Based: No

•Activation Required: No

Program Details

•PLEASE Maximum benefit and copay cost may vary on a monthly, quarterly, and/or annual basis, depending on each individual patient’s plan of insurance and other prescription drug costs

•Eligible commercially insured patients may pay as little as $0 a month

•Restrictions, including monthly maximums, may apply

•For questions, call 8557854782 Monday through Friday, 8 am–8 pm ET

Enrollment Forms

Enrollment Form