The patient is responsible for the first $9 of their copay after the patient's insurance has been applied and the card pays up to the next $150 per 1-month fill and $450 per 3-month fill, up to a maximum savings of $2250 annually. Prescriber ID# required on prescription. Not for use by residents of the Commonwealth of Massachusetts or the State of California. May not be used to obtain prescription drugs paid for by Federal or State Healthcare Programs including Medicare Part D. This offer is not valid for those patients under 18 years of age or patients whose plans do not permit use of a copay card. Void where prohibited by law, taxed or restricted.
Patient Instructions: In order to redeem this card you must have a valid prescription for VASCEPA® (icosapent ethyl) and otherwise meet all eligibility criteria. Follow the dosage instructions given by the doctor. This card may not be redeemed for cash. Cardholders with questions, please call 1-855-497-8462.
Pharmacist Instructions for Patients with Commercial Insurance Claims: Submit the claim to the primary Third Party Payer first, 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., 8). The patient is responsible for the first $9 after the patient's insurance has been applied and the card pays up to $150 per 1-month fill and $450 per 3-month fill, up to a maximum savings of $2250 annually. Reimbursement will be received from CHANGE HEALTHCARE.
Pharmacist Instructions for Cash-Paying Patients Without Insurance: Submit this claim to CHANGE HEALTHCARE. A valid Other Coverage Code (e.g., 1) is required. The patient is responsible for the first $9 and the card pays up to the next $150. 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 1-800-422-5604.
Program managed by Connective RX, LLC on behalf of Amarin Pharma, Inc. Amarin and Connective RX reserve the right to rescind, revoke or amend this offer without notice at any time. The card is not transferrable. Void where prohibited by law, taxed, or restricted.
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