Eligibility For Patients

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Required Field
Are you a United States Resident?
Do you currently have commercial health insurance for a portion of your prescription drug cost?
Are you enrolled in any federal or state subsidized healthcare program that covers a portion of your prescription drug costs, including Medicare (such as Medicare Part D prescription drug benefit), Medicaid, TRICARE, or any other federal or state healthcare plan, including pharmaceutical assistance programs?

*By Activating the Co-pay card, You agree to the following statements:

  • The information entered above is true and correct.
  • You are not enrolled in a federal or state-funded prescription drug benefit program, such as Medicare or Medicaid, or any private indemnity or HMO insurance plan that reimburses you for the entire cost of your prescription drug.
  • You agree that you are not medicare-eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees.
  • Should you begin receiving prescription benefits from one of these types of programs at any time, you will no longer participate in this saving program.


  • Patient must meet the eligibility requirements of the NUBEQA $0 Co-Pay Program; for example, only commercially insured patients are eligible
  • Patient must inform the NUBEQA $0 Co-Pay Program of change in insurance status
  • It is required that the patient understand, accept, and meet the terms of all the NUBEQA $0 Co-pay Program requirements
  • Use of the NUBEQA $0 Co-pay Program must be consistent with and not prohibited by the requirements of the patient’s health insurance
  • The NUBEQA $0 Co-pay Program benefit has a max amount of $25,000 per year, per patient
  • The NUBEQA $0 Co-pay Program is for commercially insured patients using NUBEQA for an approved FDA indication
  • The NUBEQA $0 Co-pay Program does not cover costs for charges associated with patient visits
  • Offer valid only for patients treated in the USA, including Puerto Rico, Guam and US Territories
  • Bayer reserves the right to determine eligibility, monitor participation, equitably distribute product and modify or discontinue the NUBEQA $0 Co-Pay Program at any time with or without notice
  • Patient agrees to provide necessary health information to the administrators of the NUBEQA $0 Co-Pay Program
  • For questions about the NUBEQA $0 Co-Pay Program, please call us at 1-647-245-5642.
Nubeqa copay program