Eligible patients can pay as little as $5 for Sodium Oxybate Oral Solution for a 30-day fill, subject to monthly and annual maximum benefit. The Coupon Program is only available for residents of the US, Puerto Rico, and the other US territories who have commercial insurance with out-of-pocket expenses, including co-pay/
The voucher is good for up to one-month’s free supply (maximum of three bottles) for a patient’s first-time shipment. There is a lifetime limit of one voucher per patient. The voucher is for commercially insured patients that have been prescribed XYREM with substitution allowed for its FDA-approved indications. The voucher is only available for residents of the US, Puerto Rico, and the other US territories. The voucher is not valid for beneficiaries of Medicare, Medicaid, VA, or other federal or state healthcare programs. The voucher requires a valid, signed prescription for XYREM completed by the prescriber with substitution allowed, in addition to any other local or state prescription requirements. The voucher is for patients enrolled in the XYWAV and XYREM REMS. The voucher is for patients that are experiencing an insurance coverage decision delay greater than 10 calendar days for Sodium Oxybate Oral Solution, or for patients changing from XYREM to Sodium Oxybate Oral Solution who are at risk of therapy interruption (i.e., less than seven calendar days from the patient’s next XYREM or Sodium Oxybate Oral Solution delivery date). The voucher may not be submitted by the patient, pharmacy, or prescriber to seek reimbursement for all or any part of the benefit received by the patient through this voucher. The free supply of Sodium Oxybate Oral Solution cannot be used toward any out-of-pocket costs under any health insurance or prescription drug plan. The voucher may not be applied retroactively and does not cover refills. The voucher cannot be combined with any other voucher, certificate, coupon, rebate, or similar offer. Use of the voucher is not contingent on any purchase requirement. This is not a discount, rebate, or insurance program. The voucher is not valid where otherwise prohibited by law. It is illegal for any person to sell, purchase, trade, or counterfeit the voucher. Jazz Pharmaceuticals or Authorized Generic partner reserves the right to terminate or modify this program at any time with or without notice.
The Bridge Program is for patients who have commercial insurance that are at risk of therapy interruption due to a change in insurance or change in insurance coverage for Sodium Oxybate Oral Solution. The Bridge Program benefit is a free drug offer valid for up to a one hundred and twenty (120) day supply of Sodium Oxybate Oral Solution or until commercial insurance coverage has been established or you have transitioned to a different therapy or discontinued therapy, whichever comes first, given in up to fifteen (15) day increments. The Bridge Program is only available for residents of the US, Puerto Rico, and the other US territories. The Bridge Program is for patients that have been prescribed XYREM with substitution allowed for its FDA-approved indications. The Bridge Program is not valid for beneficiaries of Medicare, Medicaid, VA, or other federal or state healthcare programs, if you pay for your prescription in cash or if you choose not to use your insurance coverage. The Bridge Program requires a valid, signed prescription for XYREM completed by the prescriber with substitution allowed, in addition to any other local or state prescription requirements. The Bridge Program is for patients enrolled in the XYWAV and XYREM REMS. The Bridge Program is not health insurance. The pharmacy, patient, or prescriber cannot submit a claim for reimbursement under any federal, state, or other governmental programs or any third party for any part of the benefit received by the patient through the Bridge Program. It is illegal to (or offer to) sell, purchase, or trade this offer. This offer is nontransferrable. This offer is void where prohibited by law. No purchase necessary. If your insurance changes, you must inform the pharmacy immediately. Based on your insurance change, you may no longer be able to participate in the Bridge Program. Jazz Pharmaceuticals or Authorized Generic partner reserves the right to terminate or modify this program at any time and without notice and in its sole discretion.