1. This offer is valid only for eligible patients and is good for use only with a valid prescription for vitaMedMD brand prenatal vitamins or Prena1 generic prenatal vitamins at the time the prescription is filled by the pharmacist and dispensed to the patient.
2. During the active date of the Program, eligible patients may pay $25 or less on each of up to twelve (12) 30-day prescriptions; $75 or less on each of up to four (4) 90-day prescriptions.
3. Maximum savings limit applies; patient out-of-pocket expense may vary.
4. This offer is valid for commercially insured patients only.
5. This offer is not valid for use by patients enrolled in Medicare, Medicaid, or other federal or state programs (including any state pharmaceutical assistance programs), or private indemnity or HMO Insurance plans that reimburse the patient for the entire cost of the prescription drugs.
6. Void outside the United States and its territories or where prohibited by law, taxed, or restricted.
7. This card is not health insurance, redeemable for cash, or transferable, and is not valid with any other offer.
8. TherapeuticsMD, vitaMedMD, and BocaGreenMD (collectively, the Companies) reserve the right to amend or end this program at any time without notice. Data related to the patient's redemption with this Co-pay Card may be collected, analyzed, and shared with the Company for market research and other purposes related to assessing coupon and rebate programs. Any data will be aggregated and de-identified.
9. By redeeming this card, you acknowledge that you are an eligible patient and that you understand and agree to comply with the terms and conditions of this offer.
For questions about this program please call 1-855-993-2665.Authorization to Contact
I understand and consent to TherapeuticsMD contacting me using the information provided in this form, and to enroll me in, operate, and administer TherapeuticsMD's patient support services and/or programs as described. I understand TherapeuticsMD and its affiliated companies may use my information to conduct market research, send other marketing communications and information via phone, email, text and push notification in their apps.
Pharmacist Instructions for a patient with an eligible third-party payer: When you redeem this card, you certify that you have not submitted and will not submit a claim for reimbursement under any federal, state, or other government programs for this prescription.
• Submit the claim to the primary third-party payer first and then submit the balance due to Change Healthcare as a Secondary Payer COB [coordination of benefits] with patient responsibility amount and a valid Other Coverage Code, (e.g. 3 or 8). The patient’s out-of-pocket expense will be reduced up to the maximum savings limit for the program. Reimbursement will be received from Change Healthcare.
• Valid Other Coverage Code required. For any questions regarding Change Healthcare online processing, please call the Help Desk at 1-800-433-4893. Program managed by COMP on behalf of TherapeuticsMD.