Patient Savings Program
Click here for
Important Safety Information
Pay no more than $25
for each of 3 Nascobal Nasal Spray prescriptions
If your insurance co-pay is:
- $125 or less, you pay $25
- greater than $125, save $100
Program Rules & Instructions
Patient: Redeem this card ONLY when accompanied by a valid prescription for Nascobal® Nasal Spray. This card is valid for out-of-pocket costs exceeding $30 up to a maximum benefit of $100 on the next 6 prescriptions of Nascobal (Cyanocobalamin, USP) filled through 12/31/2013.
Pharmacist Instructions for a Cash-Paying Patient: Submit this claim to Therapy First Plus. A valid Other Coverage Code (e.g. 1) is required. The patient is responsible for the first $30 and reimbursement will be received from Therapy First Plus. The card will pay up to $100 for each of 6 uses.
Pharmacist instructions for a patient with an Eligible Third Party: Submit the claim to the primary Third Party Payer first, then submit the balance due to Therapy First Plus as a Secondary Payer as a copay only billing using a valid Other Coverage Code, (e.g. 8). The patient is responsible for the first $30 and reimbursement will be received from Therapy First Plus. The card will pay up to $100 for each of 6 uses.
Valid Other Coverage Code required. For any questions regarding Therapy First Plus online processing, please call the Help Desk at 1-800-422-5604.
Patients with questions should call 1-866-439-3685. Offer not valid for prescriptions reimbursed under Medicaid, a Medicare drug benefit plan, TRICARE, or other federal or state programs (such as medical assistance programs). If you are eligible for drug benefits under any such program, you cannot use this card. Offer is not valid in Massachusetts and Vermont or where prohibited. The parties reserve the right to amend or end this program at any time without notice.
Patient Education Brochure
Give your patients
more information
about Nascobal
