Eyevance® is committed to helping all patients have affordable access to ZERVIATE™
Pay as little as $45
For patients for whom ZERVIATE is covered by commercial insurance.a
Pay as little as $45
For patients for whom ZERVIATE is not covered by commercial insurance, Medicare Part D, or Medicare Advantage.a
aTo the Patient: You must activate and present this card to the pharmacist with a valid prescription to participate in this program. If you have questions regarding your eligibility or benefits, or if you wish to discontinue your participation, call the Eyevance Copay Savings Program at 866-747-0976 (8:00 am–8:00 pm EST, Monday–Friday). For patients whose ZERVIATE prescriptions are covered by commercial insurance, use of this card may reduce your copayment responsibility to as little as $45. For patients whose ZERVIATE prescriptions are not covered by either commercial or government insurance, use of this card may reduce your cost for ZERVIATE to as little as $45. This program is subject to overall maximum support amounts and is valid for up to 4 prescriptions. This coupon is not valid for prescriptions paid for in part or full under any state or federally funded program, such as but are not limited to Medicaid, VA, DOD, or Tricare, including any state prescription drug assistance programs. Patients who have prescription drug coverage under Medicare Part D or Medicare Advantage may take advantage of this offer, provided that they acknowledge that by doing so they will not seek any prescription coverage or reimbursement from their insurer for the cost of ZERVIATE, or report any amounts paid for ZERVIATE as part of their “true out-of-pocket expenses” under Medicare Part D or Medicare Advantage. When you use this card, you are certifying that you understand the program rules, regulations, and terms and conditions, and that you have responded truthfully to questions when activating the card. This offer expires on 12/31/20.
To the Pharmacist: When you process this card, you are certifying that you have read, understood, and are in compliance with the terms and conditions pertaining to this program. You are further certifying that you have not submitted and will not submit a claim for reimbursement under Medicare Part D or similar federal or state programs, including any state medical pharmaceutical assistance program for this prescription.
- Submit transaction to McKesson Corporation using [BIN #610524].
- If primary commercial prescription insurance exists, input card information as secondary coverage and transmit using the COB segment of the NCPDP transaction. Applicable discounts will be displayed in the transaction response.
- Acceptance of this card and your submission of claims for the Eyevance Copay Savings Program are subject to the LoyaltyScript® program Terms and Conditions posted at www.mckesson.com/mprstnc.
- The LoyaltyScript® card is not valid for use with any other prescription drug discount or cash cards for ZERVIATE. Claims submitted utilizing the program are subject to audit or validation.
- For questions regarding setup, claim transmission, patient eligibility or other issues, call the LoyaltyScript® for Eyevance Copay Savings Program at 866.747.0976 (8:00 am–8:00 pm EST, Monday–Friday).
Eyevance reserves the right to rescind, revoke, or amend this offer at any time.
COB=coordination of benefits; NCPDP=National Council for Prescription Drug Programs.