Your participation in this program confirms that this offer is consistent with your insurance coverage and that you will report the value received if required by your insurance provider. has the right to rescind, revoke, or amend this program at any time without notice. Offer void where prohibited by law, taxed, or restricted. Patients are not eligible if they are under 18 years of age or are covered in whole or in part by any state program or federal healthcare program, including, but not limited to, Medicare or Medicaid (including Medicaid managed care), Medigap, VA, DOD, or TRICARE. This offer is only valid in the United States and Puerto Rico and is not transferable. By participating in this program, you are certifying that you will comply with the terms and conditions described in the Restrictions section below. Participation in this program must comply with all applicable laws and regulations as a pharmacy provider. When you apply for 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.
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For any questions regarding Therapy First Plus online processing, please call the Help Desk at 1-80. Reimbursement will be received from Therapy First Plus. A valid Prescriber ID# is required on the prescription. Eligible patients are responsible for as little as $10, with up to $8,000 in annual savings.
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Submit the claim to the primary Third Party Payer first, then submit the balance due to Therapy First Plus as a Secondary Payer COB with patient responsibility amount and a valid Other Coverage Code (eg, 8). As a condition of payment, you certify that you are in compliance with all program rules, terms, and conditions, as well as with any obligations to provide notice of your participation in this program to third-party payers as required by law, contract, or otherwise. When you use this card, you are certifying that you have not submitted and will not submit a claim for reimbursement under any federal, state, or other governmental programs for this prescription. Patients with questions about the offer should call 1-88.
By using this offer, you are certifying that you meet the eligibility criteria (not a member of a federal, state, or government insurance program) and will comply with the terms and conditions described in the Restrictions section below. In order to redeem this offer you must have a valid prescription for ABILIFY MAINTENA ® (aripiprazole).
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