Copay Coupon Card

Pay As Little As $5
With the Copay Coupon Card*

With the ZYDELIG^® AccessConnect^® Copay Coupon Card, eligible individuals pay as little as $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

1. After you prescribe ZYDELIG, review the Eligibility Requirements listed below with your patient.
2. Advise your patient to activate, enroll, or replace their Copay Coupon Card at: zydeligcopay.com.

Terms and conditions

• The ZYDELIG^® Co-Pay Coupon Program will cover the out-of-pocket costs of your eligible ZYDELIG prescription after you pay the first $5 per prescription fill, up to a maximum of 25% of the catalog price annually.
• The ZYDELIG Co-Pay Coupon (“Coupon”) can be used only by eligible residents of the U.S., Puerto Rico, or U.S. territories at participating eligible pharmacies in the U.S., Puerto Rico, or U.S. territories. Product must be dispensed in the U.S., Puerto Rico, or U.S. territories. Coupon user must be at least 18 years old to use the Coupon for themselves or on behalf of a minor.
• The Coupon is limited to one per person and is not transferable. No substitutions are permitted. The Coupon is only available with a 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 Sciences, Inc. ("Gilead")'s patient assistance program for that product(s).
• The Coupon is not insurance and is not intended to substitute for insurance. The Coupon is valid only for patients with commercial insurance and is not valid for prescriptions that are eligible to be reimbursed:
• In whole or in part by Medicare or a Medicare Part D plan, Medicaid, TRICARE, VA, DOD, Puerto Rico Government Health Insurance Plan, or any other state or federally 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 prescription drugs or prohibit the Coupon’s use.

• Medicare Part D enrollees who are in the prescription drug coverage gap (the “donut hole”) are not eligible for the Coupon. Patients who begin receiving prescription benefits from Government Programs at any time will no longer be eligible to use the Coupon.
• 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 Coupon, as may be required.
• It is illegal to sell, purchase, trade, or counterfeit, or offer to sell, purchase, trade, or counterfeit the Coupon.
• Certain information pertaining to your use of the Coupon will be shared with Gilead, the sponsor of the Coupon, and its affiliates. The information disclosed will include the patient co-pay ID, pharmacy demographics, prescriber information, and details relating to the coupon claim, such as co-pay amount, insurance details, and the therapy received. For more information, please see the Gilead Privacy Policy at www.gilead.com.

Gilead Sciences reserves the right to terminate, rescind, revoke, or modify the Coupon at any time without notice.