Copay Coupon Card
Pay No More Than $5
With the Copay Coupon Card*
With the ZYDELIG® AccessConnect® Copay Coupon Card eligible individuals pay no more than $5 for a 30-day supply of ZYDELIG®.
Patients with government healthcare prescription drug coverage including patients in the Medicare Part D coverage gap or "donut hole" are not eligible.
The Copay Coupon Card will cover the out-of-pocket costs for ZYDELIG after the first $5 per prescription fill, up to a maximum of 25% of the catalog price.
This program is for individuals with commercial/private insurance and copays above $5.
Start with two simple steps
- After you prescribe ZYDELIG, review the Eligibility Requirements listed below with your patient.
- Advise your patient to activate, enroll, or replace their Copay Coupon Card at: activatethecard.com/zydelig.
Terms and conditions
- The ZYDELIG Copay Coupon Program will cover the out-of-pocket costs of a patient’s ZYDELIG prescriptions after the patient pays the first $5 per prescription fill, up to a maximum of 25% of the catalog price of a 12-month supply of ZYDELIG. The card is valid for 12 months from the time received or 15 fills within that 12-month period.
- The Gilead Copay Coupon Card (“Card”) can be used only by eligible residents of the U.S., Puerto Rico, or U.S. territories at participating eligible retail, specialty, or mail-order pharmacies in the U.S., Puerto Rico, or U.S. territories. Product must originate in the U.S. or Puerto Rico, or U.S. territories. You must be 18 years or older to use the Card for yourself or a minor.
- The Card is limited to one per person and is not transferable. No substitutions are permitted. This Card is available for each valid prescription. The offer cannot be combined with any other coupon, free trial, discount, prescription savings card, or other offer. Patient may not be currently receiving free drug assistance through Gilead Science Inc.'s (Gilead) patient assistance programs.
- The Card is not insurance and is not intended to substitute for insurance.
- The Card is valid only for patients with commercial insurance or cash-pay patients and is not valid for prescriptions that are eligible to be reimbursed:
- In whole or part, by Medicare, a Medicare Part D Plan, Medicaid, TRICARE, VA, DoD, Puerto Rico Government Health Insurance Plan, or any other federal or state-funded healthcare benefit program (collectively, “Government Programs”); or
- By commercial plans or other health or pharmacy benefit programs that reimburse for the entire cost of prescriptions drugs.
- Patients without insurance coverage or who have commercial insurance that does not cover the Gilead product are considered “cash pay” patients. Medicare Part D enrollees who are in the prescription drug coverage gap (the “donut hole”) are not considered cash pay, and are not eligible for the copay coupon. Patients who begin receiving prescription benefits from such Government Programs at any time will no longer be eligible to use the Card. Void where prohibited by law, taxed, or restricted.
- Patient, pharmacist, and prescriber agree not to seek reimbursement for all or any part of the benefit received by the patient through the offer. Both patient and pharmacist are each individually responsible for reporting receipt of coupon benefit to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the Card, as required.
- It is illegal to sell, purchase, trade, or counterfeit, or offer to sell, purchase, trade, or counterfeit the Card.
Gilead reserves the right to terminate, rescind, revoke, or modify this Card at any time without notice.