- Multiple system atrophy (MSA), a Parkinson's-like disorder with more widespread effects on the brain and body.- Parkinson's disease (PD), a neurodegenerative disease that causes slowness in muscle movement as well as shaking in the hands.NORTHERA (droxidopa) is a prescription medication used to reduce dizziness, lightheadedness, or the "feeling that you are about to black out" in adults who experience a significant drop in blood pressure when changing positions or standing (called symptomatic neurogenic orthostatic hypotension (nOH)) and who have one of the following: For questions regarding patient eligibility or other issues, call the Northera Support Center at 1-84 (8:00 am-8:00 pm ET, Monday through Friday).For questions regarding claim transmission call the LoyaltyScript® program at 1-80 (8:00 am-8:00 pm ET, Monday through Friday).Acceptance of this card and your submission of claims are subject to the LoyaltyScript ® program.Applicable discounts will be displayed in the transaction response.
Input card information as secondary coverage and transmit using the COB segment of the NCPDP transaction.Submit transaction to McKesson Corporation using BIN #610524.
By participating in the Copay Assistance program, the patient acknowledges and agrees that he/she is eligible to participate and that he/she understands and agrees to comply with the General and Copay Assistance Terms and Conditions. Patients should confirm their out-of-pocket cost with their pharmacy at the time the pharmacy calls to dispense the prescription.
If the patient's total out-of-pocket pharmacy bill exceeds the cap established by Lundbeck, the patient will be responsible for the additional balance. Patients must pay at least $10 for each 30-day prescription. Patient questions and requests to discontinue participation in the program can be directed to 1-84 (8:00 am-8:00 pm ET, Monday through Friday).Įligible commercially insured patients age 17 and older with a valid Northera prescription may participate in this program. There is no future purchase requirement associated with the Offer. The Offer is valid only in the USA where allowed by law. The Offer is intended to comply with all applicable laws and regulations, including, without limitation, the federal Anti-Kickback Statute, its implementing regulations, and related guidance interpreting the federal Anti-Kickback Statute. Lundbeck reserves the right to rescind, revoke, terminate or amend the Offer without notice.
#Copay assistance free#
The Offer has no cash value and may not be used in combination with any other discount, coupon, rebate, free trial, or similar offer for the specified prescription. The selling, purchasing, trading, or counterfeiting of the Offer is prohibited by law. Patients are responsible for complying with any obligations or requirements imposed by their insurance plans. The copay prescriptions shall not be submitted for reimbursement to any public third-party payer, including Medicaid or Medicare, or any other similar federal or state healthcare program. The Offer applies only to prescriptions filled before the program expires or terminates. The Offer is valid only for use with a valid prescription for Northera at the time the prescription is filled by the pharmacist and dispensed to the patient. In addition, patients may not use the Offer if they are Medicare-eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees. Patients are not eligible for the Offer if they are self-pay or if the prescription is eligible to be reimbursed, in whole or in part, by any state or federal health care programs, including but not limited to Medicare or Medicaid, Medigap, VA, DOD, or TRICARE. Terms and Conditions: Only commercially insured patients age 17 and older whose insurance policy provides coverage for Northera ® (droxidopa) and who are not reimbursed for the entire cost of the prescription are eligible for the copay assistance (the “Offer”). Terms and Conditions for the Northera Commercial Copay Assistance Program
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