Using Your Card
Option 1: You are obtaining NUBEQA directly from a pharmacy provider:
- During your eligibility period, the NUBEQA $0 Co-pay Program may pay 100% of your co-pay or coinsurance up to a maximum of $25,000.
- Your co-pay assistance card should be used along with your primary insurance card each time you use eligible pharmacy services as prescribed by your physician. Tell your pharmacy provider that you would like to use your NUBEQA $0 Co-pay Card. The pharmacy will require the information from your card at the time NUBEQA is obtained. If the pharmacy has questions regarding the program, they may contact, the NUBEQA $0 Co-pay Program at 1-647-245-5642.
Option 2: You obtain NUBEQA from the pharmacy without using your co-pay card and the co-pay/coinsurance for NUBEQA is paid directly by you, the patient:
- During your eligibility period, the NUBEQA $0 Co-pay Program may pay 100% of your co-pay or co-insurance up to a maximum of $25,000.
- You may submit a request for reimbursement to the NUBEQA $0 Co-pay Program. You must provide a receipt for your co-payment. This should include a statement from your pharmacy indicating the total amount charged for Nubeqa and your co-pay responsibility.
- In addition to the receipt mentioned above, please complete the attached Co-pay Expenditure Form and submit to NUBEQA $0 Co-pay Program. This contains the information we require to process your request for reimbursement of your co-pay.
- The NUBEQA $0 Co-pay Program will mail a reimbursement check directly to you, which will generally be sent within 4-6 weeks of the review.
All payment and/or reimbursement requests for NUBEQA must be received by the NUBEQA $0 Co-pay Program within 6 months of the date of service in order to be considered for payment. If your medical and/or pharmacy provider is submitting claims/invoices for NUBEQA directly to the NUBEQA $0 Co-pay Program on your behalf, please follow-up with your service provider to make sure all payment and/or reimbursement requests for NUBEQA are submitted (along with necessary supporting documentation) to the NUBEQA $0 Co-pay Program within the 6 month timeframe.
Please note, Bayer reserves the right to make eligibility determinations, monitor participation, ensure equitable product availability and modify or discontinue the NUBEQA $0 Co-Pay Program for NUBEQA at any time.
If you have any questions about your participation, please feel free to contact us at 1-647-245-5642 Monday through Friday 8:00 a.m. to 8:00 p.m. ET.