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BRINSUPRI Copay Savings Program terms and conditions

Patients who are eligible may pay as little as a $0 copay every month. Patient will be responsible for any copay amounts exceeding program limits. Depending on the private or commercial health insurance plan, savings may apply toward copay, coinsurance, or deductible. Patients should keep in mind that copayments, coinsurance, and deductibles are all different types of out-of-pocket costs and you may still have out-of-pocket costs even if you are eligible for this program. Patients should refer to their insurance plan documents if they have questions related to their total out-of-pocket costs for BRINSUPRI.

Who is eligible?

Patients who have been prescribed BRINSUPRI, are at least 12 years of age, a resident of the 50 United States, the District of Columbia, or Puerto Rico, and have commercial or private health insurance may be eligible for the BRINSUPRI Copay Savings Program. BRINSUPRI must be covered by commercial or private insurance. This program is not valid for cash-paying customers. This offer is not valid for prescriptions covered by or submitted for reimbursement under Medicaid, Medicare, VA, DoD, TRICARE or similar federal or state programs, including any state pharmaceutical assistance program. Patients who are currently ineligible for the BRINSUPRI Copay Savings Program may reapply if their circumstances change.

This is not an insurance benefit, and does not cover or provide support for supplies, procedures, or any physician-related services associated with BRINSUPRI. General, non-product specific insurance deductibles are also not covered by this program. Insmed reserves the right to rescind, revoke, terminate, or amend this offer, eligibility, and terms and conditions at any time without notice. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer. This offer is not conditioned upon, or reward for, any past, present, or future purchase, including refills. The copay card is non-transferable, limited to one per person, and cannot be combined with any other offer or discount. This program is not valid where prohibited by law, taxed, or restricted. Offer has no cash value.

For patients

If your prescription is covered by insurance, you may need to notify the insurance carrier of redemption of this copay card. By redeeming this copay card, you are certifying that (1) you are not a beneficiary of any government-funded program as previously noted; (2) should you begin receiving prescription benefits from any government-funded program, you will withdraw from this program; and (3) you understand that adherence to the terms and conditions of this offer is necessary to ensure compliance with laws pertaining to any government-funded program. For questions regarding your eligibility or benefits or if you wish to discontinue your participation, please contact your pharmacy.

Some prescription drug plans have established programs referred to as “copay maximizer” programs in which the amount of the patient’s out-of-pocket costs is adjusted to reflect the availability of support offered by the copay support program. Patients enrolled in a copay maximizer may receive varied program benefits to ensure the program funds are used for the benefit of the patient.

BY PARTICIPATING IN THE BRINSUPRI COPAY SAVINGS PROGRAM, YOU AND YOUR PHARMACIST UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.