Any out-of-pocket costs remaining after the application of the savings card may not be paid by your health plan, pharmacy benefit programs, or any other program. You also agree that you are personally responsible for paying any amount of co-pay required after the savings card is applied. Except where prohibited by applicable state law, if your insurance company or health plan implements either an accumulator adjustment or co-pay maximizer program, you will not be eligible for, and agree not to use, co-pay assistance because these programs are inconsistent with our agreed intent that this program is solely for your benefit. Co-pay maximizers are programs in which the amount of your out-of-pocket costs is increased to reflect the availability of support offered by a manufacturer assistance program. An accumulator adjustment program is one in which payments made by you that are subsidized by manufacturer assistance do not count toward your deductibles and other out-of-pocket cost sharing limitations. Some health plans have established programs referred to as “accumulator adjustment” or “co-pay maximizer” programs. If at any time a patient begins receiving drug coverage under any such federal, state, or government-funded healthcare program, patient will no longer be able to use the Skyrizi Complete Savings Card and patient must call Skyrizi Complete at 1.866.SKYRIZI to stop participation. By enrolling in the co-pay assistance program, you agree that this program is intended solely for the benefit of you, the patient. Co-pay assistance program is not available to patients receiving reimbursement under any federal, state, or government-funded insurance programs (for example, Medicare, Medicare Advantage, Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs programs) or where prohibited by law or by the patient’s health insurance provider. Eligibility: Available to patients with commercial insurance coverage for SKYRIZI who meet eligibility criteria. Patient or healthcare provider is required to submit an Explanation of Benefits (EOB) following each infusion and/or laboratory test to the Co-Pay Program. This benefit covers SKYRIZI® (risankizumab-rzaa) alone or for SKYRIZI with product associated infusion (maximum savings limit of $1,000 per year applies) and eligible liver enzyme and bilirubin lab monitoring costs (maximum savings limit of $1,000 per year applies) where the full cost is not covered by a patient’s insurance. Skyrizi Complete Savings Card Terms & Conditions
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