See if
you're
eligible* to
start saving
†
Indicates required field.
†
Which prescription drug coverage do you have?
Although you do not qualify for the CONTRAVE Savings Coupon Card, there is still good news. Even without health insurance, you can still pay $99 or less per month for CONTRAVE with the CONTRAVE Connex™ Patient Support Program.‡
Your CONTRAVE
Coupon Card account
ID number is:
[0000000000]


Did you know that you are also eligible for the CONTRAVE Connex™ Patient Support Program? With CONTRAVE Connex™, you can pay $99 or less for CONTRAVE.‡
*
Terms and Conditions may vary depending upon your insurance and pharmacy. Payment will depend on your pharmacy and your insurance. The CONTRAVE Savings Coupon Card cannot be used if you are currently a Medicaid Beneficiary. Medicare Part D and TRICARE beneficiaries are eligible for the CONTRAVE Savings Coupon Card. However, to receive the CONTRAVE Savings Coupon Card benefits, your prescription will be processed with the assumption that you are a cash-paying customer. For Medicare Part D patients, the cash payments you make for CONTRAVE will not count towards your true out-of-pocket expenses. If Medicare or TRICARE coverage status for CONTRAVE changes in the future, your CONTRAVE Savings benefits may change too. By using the CONTRAVE Savings Coupon Card, you agree to report your use of this offer to any Third Party that reimburses you or pays for any part of the CONTRAVE prescription price. Use of this offer is confirmation that you are permitted under the terms and conditions of the health benefit plan(s) covering your prescriptions, to take advantage of co-pay coverage programs. You additionally agree that you will not submit the cost of any portion of the product dispensed pursuant to this offer to a federal or state healthcare program for purposes of counting it toward your out-of-pocket expenses. The following benefits are based on a 30-day supply of 120 tablets. All other filled quantities will be prorated by tablet for initial out-of-pocket co-pay cost, final co-pay and max benefit amount. For patients with a initial out-of-pocket co-pay obligation of $123.60 or less for a 30-day prescription, 120 tablets, the offer will cover any amount over $20 up to a maximum benefit of $104.40. For patients with a co-pay obligation of $157.20 or less for a 30-day prescription, 120 pills or fewer, the offer will cover any amount over $50 up to a maximum benefit of $108.00. For patients with a co-pay obligation of $196.80 or less for a 30-day prescription, 120 pills, the offer will cover any amount over $125 up to a maximum benefit of $72.00. For patients with a co-pay obligation of between $199.20 and $390.00 for a 30-day prescription, 120 pills, the offer will cover any amount over $125 to a maximum benefit of $265.20. For patients with a co-pay obligation greater than $391.20 to $644.40 for a 30-day prescription, 120 pills, this offer will cover any patient obligation amount over $199, up to a maximum benefit of $446.40. For those patients with insurance but their insurance does not cover or those without coverage, this offer will cover any patient obligation amount over $199, up to a maximum benefit of $446.40. Any claim exceeding the max benefit will be applied to the final co-pay. Additionally, the CONTRAVE Savings Coupon Card cannot be used if you are purchasing your prescription through the Get CONTRAVE Now® service.
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When using a partner pharmacy, if your insurance covers CONTRAVE, the lowest you pay may be $0 through our home delivery partner pharmacy program. If you don’t have insurance or if your insurance doesn’t cover CONTRAVE, you will pay no more than $99. The savings program is offered by our partner pharmacies. Subject to patient eligibility.