Qulipta Complete Savings Card - Non-covered benefit

Funded

About

The Qulipta Complete Savings Card - Non-covered benefit offers significant savings for patients prescribed Qulipta. The program is designed for patients with private insurance who face coverage challenges. By leveraging the Qulipta Complete Savings Card, eligible patients can access important cost-saving opportunities for their Qulipta medication.

Insurance requirements: Commercially insured

Enrollment Forms

Enrollment Form

Benefits

•4 maximum fills per year

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: No

•Activation Required: No

Program Details

•Commerciallyinsured patients for whom coverage is not available because the insurer has not established a coverage review process, may be eligible to receive up to (a) three onemonth fills at no charge for an FDA approved indication between January 1, 2024 and March 31, 2024 if the patient has redeemed a coupon under the Qulipta Complete Savings Card between July 1, 2023 and December 31, 2023, or (b) four onemonth fills at no charge for an FDA approved indication if (1) the patient’s first redemption of a coupon under the Qulipta Complete Savings Card occurs on or after January 1, 2024 or (2) the patient’s first redemption of a coupon under the Qulipta Complete Savings Card occurs prior to July 1, 2023 but has not redeemed a coupon under the Qulipta Complete Savings Card between July 1, 2023 and December 31, 2023

Enrollment Forms

Enrollment Form

Other Programs

HealthWell: Migraine

Commercially Insured

Medicare / Medicaid

Underinsured

Uninsured

Max Saving: $4000/year*

myAbbVie Assist: Qulipta, Ubrelvy

Commercially Insured

Medicare / Medicaid

Underinsured

Uninsured

Pay as low as

$0/ fill

Other Tools for Qulipta

Check medication interactions

Get prior authorization forms