3 simple steps to instant savings
- This is a reusable card; use for an unlimited number of customers†
- Use the codes on the card to process claims
- Bookmark this page for easy reference
†This card expires on 12/31/2016
Eligibility for The NEXIUM Pharmacy Savings Card
Who is eligible?
- Those with commercial insurance
- Commercially insured customers whose co-pay is more than $15 may receive up to $125 in savings per 30-day supply*
- Uninsured (cash-paying customers)
- If a customer does not have prescription coverage, they may receive $125 in savings per 30-day supply*
Who is not eligible?
- Customers with prescriptions purchased under Medicaid, Medicare, or similar state or federally funded health care programs
- Certain other eligibility restrictions may apply*
How do I process claims?
Pharmacist Instructions for a Patient With an Eligible Third Party: Submit the claim to the primary Third-Party Payer first, then submit the balance due to Therapy First Plus as a Secondary Payer COB (coordination of benefits) with patient responsibility amount and a valid Other Coverage Code (eg, 8). The patient is responsible for the first $15 on 30-day supply, $30 on 60-day supply, or $30 on 90-day supply and the card will cover up to $125 per 30-day supply. The patient is responsible for any remaining balance. Reimbursement will be received from Therapy First Plus.
Pharmacist Instructions for a Cash-Paying Patient: Submit this claim to Therapy First Plus. A valid Other Coverage Code (eg, 1) is required. The patient is responsible for the first $15 on 30-day supply, $30 on 60-day supply, or $30 on 90-day supply and the card will cover up to $125 per 30-day supply. The patient is responsible for any remaining balance. Reimbursement will be received from Therapy First Plus.
Valid Other Coverage Code Required: For any questions regarding Therapy First Plus online processing, please call the Help Desk at 1-800-422-5604. Program managed by PSKW on behalf of AstraZeneca.
ELIGIBILITY: You may be eligible for this offer if you are insured by commercial insurance and your insurance does not cover the full cost of your prescription or you are not insured and are responsible for the cost of your prescriptions.
Patients who are enrolled in a state or federally funded prescription insurance program are not eligible for this offer. This includes patients enrolled in Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DOD) programs or TriCare, and patients who are Medicare eligible and enrolled in an employer-sponsored group waiver health plan or government-subsidized prescription drug benefit program for retirees.
If you are enrolled in a state or federally funded prescription insurance program, you may not use this savings card even if you elect to be processed as an uninsured (cash-paying) patient.
This offer is not insurance and is restricted to residents of the United States and Puerto Rico or for patients younger than one month of age. This offer is valid for retail prescriptions only.
This offer will expire on 12/31/2016.