Offer does not constitute health insurance.ġ2. Void where prohibited by law, taxed, or restricted.ġ1. Offer good only in the USA, including Puerto Rico, at participating retail locations.ġ0. Allergan ® reserves the right to rescind, revoke, or amend this offer without notice.ĩ. A BOTOX ® Savings Program check will be issued to the patient upon approval of a claim.Ĩ. Claims must be submitted within 180 days of treatment date and must include a copy of (a) an Explanation of Benefits (EOB) for the BOTOX ® treatment, (b) a Specialty Pharmacy (SP) receipt for BOTOX ®, or (c) other writing showing payment of out-of-pocket BOTOX ® and treatment-related out-of-pocket costs.ħ. For residents of Massachusetts and Rhode Island, offer applies only to the cost of BOTOX ® and not to any related medical service(s).Ħ. Offer valid only for BOTOX ® and BOTOX ® treatment-related costs not covered by insurance. Offer valid for up to 5 treatments over a 12-month period.ĥ. Offer not valid for (a) patients enrolled in Medicare, Medicaid, TRICARE or any other government-reimbursed healthcare program (including any state pharmaceutical assistance programs), or private indemnity or HMO insurance plans that reimburse for the entire cost of prescription drugs (b) patients who are Medicare-eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees (c) cash-paying patients.Ĥ. $1000 per treatment with a maximum savings limit of $4000 per year patient out-of-pocket expense may vary.ģ. Based on insurance coverage, reimbursement may be up to Offer good only with a valid prescription for BOTOX ® (onabotulinumtoxinA).Ģ. * Program Terms, Conditions, and Eligibility Criteria:ġ.
#Triumeq copay card full
Please see BOTOX ® Cosmetic full Prescribing Information including Boxed Warning and Medication Guide.īOTOX ® Savings Program Terms and Conditions Data are not a guarantee of coverage, or partial or full payment, by any payers listed.įor information on BOTOX ® Cosmetic (onabotulinumtoxinA) please see. Out-of-pocket costs and insurance plans vary. †Data on file, Allergan, BOTOX ® Blended Coverage March 2021.