2015 Osphena Savings Program Frequently Asked Questions Click here for Full Prescribing Information, including Boxed WARNING regarding Endometrial Cancer and Cardiovascular Disorders. Have a question about the Osphena 30 and 90 Day Savings Program? Below are some common questions and answers that may help. Don't see what you need? Call 1-855-OSPHENA and speak to a live representative anytime. # Question Answer About the Program 1. What is the current Offer for 30 day prescription? Page 1 of 10 For Cash Patients The Savings Offer may allow patients to save up to $100 dollars off the cost of their first and fourth prescription. Cash patients are responsible for the rest of the cost of the prescription. For all other refills (2nd, 3rd, 5th and 6th), the Savings Offer may allow patients to save up to $75 off the cost of their prescription. Cash patients are responsible for the rest of the cost of the prescription. For Insured Patients Patients with insurance may save up to $100 dollars off the cost of their first and fourth prescription. For all other refills (2 nd, 3 rd, 5th and 6th), the Savings Offer may allow patients to pay a minimum of $25 for each prescription and the Savings Offer may cover the rest of the cost of the prescription up to $75. The Osphena Savings Offer is available for 6 uses (6 months). You can sign up for the Savings Offer at www.osphenasavings.com.
Remember you must have a valid prescription for Osphena before you can actually use the offer (per 30-day supply) What is the current Offer for 90 day prescription? For Cash Patients The 90 day Savings Offer may allow patients to save up to $180 dollars off the cost of a 90 day prescription for Osphena. Cash patients are responsible for the rest of the cost of the prescription. For Insured Patients Patients with insurance may save up to $180 dollars off the cost of their 90 day prescription for Osphena, after the patient pays the first $50. The 90 Day Osphena Savings Offer is available for 2 uses (6 months). You can sign up for the savings offer at www.osphenasavings.com. 2. Do I need to activate my Offer before going to the pharmacy? If yes, what is the activation number for this offer? 3. When does the Osphena Savings Offer expire? 4. Do I have to wait a number of days in between fills to get my next refill? Remember you must have a valid prescription for Osphena before you can actually use the offer (per 90- day supply) You should activate your Osphena Savings Offer before you use it by calling 1-877-208-2559 The Osphena Savings Offer expires on December 31, 2015. Shionogi Inc. reserves the right to discontinue or modify the offer at any time. The Osphena Savings Program does not limit the number of days between fills that you must wait in order to get your next refill. Your insurance may Page 2 of 10
5. Is there a maximum amount the Osphena Savings Offer will cover per use? have limitations on how quickly you can refill your monthly prescription so you should check with your provider. 30 Day Offer Patients with insurance or cash paying patients may save up to $100 off their remaining co-pay or out of pocket cost for each month s prescription. On use 2, 3, 5 and 6 the offer may cover up to $75 after the patient pays the first $25. This Osphena Savings Offer is available for 6 uses (6 months). 90 Day Offer Patients with insurance or cash paying patients may pay the first $50 and may receive up to $180 off their out of pocket costs on a 90 day (3- month prescription). This Osphena Savings Offer is available for 2 uses (6 months). 6. What if I lost my offer? If you lose your offer, you can download a new one at www.osphenasavings.com. Your pharmacy may also retain your information. 7. Can I use more than one Offer at the same time? 8. Can I use the 90 Day Offer after the 30 Day Offer? No. Only one Osphena Offer can be used at a time. Yes. Can I use the 30 Day Offer after the 90 Day Offer? 9. Can I use the Osphena Savings Program if I have deductibles that I haven t met? 10. I have more than one person in my household that may be able to use the Osphena Savings Program; how Yes. Yes, you should be able to receive savings benefits with the Osphena Savings Program. Please contact your insurance company for information pertaining to your deductible. You can only use the Osphena Savings Program if you have a valid prescription. Page 3 of 10
can I obtain more than one offer for Osphena? 11. I received the Osphena Savings Offer; does this mean I don t need to have a prescription? 12. Will my personal medical data remain confidential, or will my name and address be placed on a mailing list? 13. Is there a Patient Assistance Program for patients who cannot afford this medication? 14. Are there additional ways that I can receive extra savings? 15. Can the Osphena Savings Offer be given as a gift to someone? 16. Can the Osphena Savings Offer be used by patients with an existing prescription? 17. I am currently using the $35 Savings Offer, can I use the new 30 or 90 Day Offer? You can download an Osphena Savings Offer on the web at www.osphena.com No. The Osphena Savings Program is for use ONLY with a valid Osphena prescription. Your personal medical information will remain confidential. Shionogi will send you communications regarding the Osphena Savings Program only if you have opted in to receive such communications. You can also visit www.osphena.com to read the full Privacy Policy. Currently we do not have a Patient Assistance Program, we offer the Osphena Savings Program only. No, right now we offer the Osphena Savings Program only. No. The Osphena Savings Program has no cash value, is not transferable, and can ONLY be used with a valid Osphena prescription. 30 Day Offer If you are eligible, you can use your offer up to 6 times before the offer expires on December 31, 2015. Shionogi Inc. reserves the right to discontinue or modify the Program at any time. 90 Day Offer If you are eligible, you can use your offer up to 2 times before the offer expires on December 31, 2015. Shionogi Inc. reserves the right to discontinue or modify the Program at any time. If you're an existing patient who's currently using the $35 Savings Offer, you're eligible for either the 30 Day Supply Offer or the 90 Day Supply Offer. Please check the www.osphena.com Page 4 of 10
18. I've never used my $35 Savings Offer; can I use the new 30 or 90 Day Offer? 19. What happens to existing patients who completed using the $35 Offer and have no remaining benefits? 20. What happens to existing patients who are still using the $35 Offer and have benefits remaining? 21. What happens to existing patients who completed using the 30 day card and have no remaining benefits? What happens to existing patients who completed using the 90 day card and have no remaining benefits? Eligibility 1. I am a resident of Massachusetts; can I use the Osphena (ospemifene) Savings Program? 2. Can the Osphena Savings Program be used for prescriptions reimbursed Page 5 of 10 website for updates of the savings program. Yes. Please see Terms and Conditions for specific details. If you have finished all your uses on the $35 Offer, then you will automatically begin receiving the new Pay As Little As $25 Offer at the pharmacy. This new offer is good for 6 uses. Each 30 day supply counts as one use. There is no need for a new card. On February 27, 2015, patients on the $35 Offer will be switched to the Pay As Little As $25 Offer at the Pharmacy. This new offer is good for 6 uses. Each 30 day supply counts as one use. This program to automatically occur at the pharmacy. 30 Day Offer Once the patient has reached their sixth use the pharmacist will be alerted of the new Pay as Little As $25 Offer, and should move the patient to the current Pay As Little As $25 Offer. There is no need for a new card. 90 Day Offer Once the patient has reached their third use the pharmacist will be alerted of the new offer. When the patient fills the third prescription, the pharmacist will move the patient to the current Pay As Little As $25 Offer. There is no need for a new card. Yes, the Osphena Savings Program is valid for Massachusetts residents. Unfortunately, No. If you are eligible for drug benefits under any federal or
under Medicaid, Medicare, TRICARE? 3. I have Medicare/Medicaid/Tricare, and Osphena is not covered; can I use the Osphena Savings Program? 4. I am a cash paying patient, meaning I don t have health insurance coverage. Can I use the Osphena Savings Program? 5. I have private prescription insurance but Osphena is not covered by my plan; can I still use the Osphena Savings Program with my prescription? Reimbursement 1. Can I use the Osphena Savings Program for mail order purchases? 2. If my mail order pharmacy doesn t accept Osphena (ospemifene) Savings Program, can I mail in for a reimbursement? Page 6 of 10 state drug assistance programs, you cannot use the Osphena Savings Program. As a government program they don t allow the use of a Savings Offer. See the program for complete terms and conditions. No, if you are enrolled in Medicare, Medicaid, TRICARE, or any other federal or state government healthcare or pharmaceutical assistance program providing prescription drug benefits, you cannot use the Osphena Savings Program. You can see the full Terms and Conditions on the back of the card. Yes, the Osphena Savings Program is available to patients without insurance as a cash paying patient. Yes, if your private insurance does not cover Osphena you can still use the savings offer as a cash paying patient. Medicare, Medicaid, TRICARE, or any other federal or state government healthcare or pharmaceutical assistance programs are excluded. Yes, the Osphena Savings Program may be used with mail order purchases with a valid prescription. Just provide your Osphena Savings Program information to the mail order Pharmacy. If your mail order Pharmacy doesn t accept your savings offer, you can mail in for reimbursement. Yes. You may get your savings via a rebate check after you have purchased your Osphena prescription via mail order. In order to receive your check, please provide the following information: The privacy
3. Is the Osphena Savings Program accepted at my pharmacy? of your healthcare information is important to us, please visit www.osphena.com for full Privacy Policy. The 11-digit ID# and GRP# that is found on the Osphena offer or a photocopy of the offer. A proof of purchase (original pharmacy receipt with pharmacy name, product name, prescription number or Rx#, date filled, quantity, and the price) Your name, address, city, state, zip, phone number, DOB, and the out of pocket payment Mail all of this information to: Osphena Claims Processing Dept. PO BOX 7017 BEDMINSTER, NJ 07921-7017 The Osphena Savings Program may be accepted at most retail pharmacies in the United States and Puerto Rico. If for some reason your pharmacy decides not to accept your offer, you can get your savings via a rebate check after you have purchased your Osphena prescription. In order to receive your check, please provide the following information: The privacy of your healthcare information is important to us, please visit www.osphena.com for full Privacy Policy. The 11-digit ID# and GRP# that is found on the Osphena offer or a photocopy of the offer. A proof of purchase (original pharmacy receipt with pharmacy name, product name, prescription number or Page 7 of 10
4. My Card is damaged (or lost); can you mail me a replacement card or do I need to visit my doctor for a new card? 5. Do I need to show my Osphena Savings Card to my pharmacist each time I get a refill? 6. My doctor doesn t have any more Osphena Savings cards; can I receive one by mail? 7. Can I mail in for reimbursement if my Osphena Savings Card did not work, I lost my card, or I forgot my card? Rx#, date filled, quantity, and the price) Your name, address, city, state, zip, phone number, DOB, and the out of pocket payment Mail all of this information to: Osphena Claims Processing Dept. PO BOX 7017 BEDMINSTER, NJ 07921-7017 Some pharmacies will store your Osphena Savings Offer number. If your pharmacy has not stored your Osphena Savings Offer information, you can download a new offer at www.osphena.com, or call 855- OSPHENA. Some pharmacies will store your Osphena Savings Card number. It is recommended that you bring your Osphena Savings Card with you, in case your Pharmacy has not stored your Osphena Savings Offer number. Yes, we will send you an Osphena Savings Card. I will need your name and address information. You can also print an offer by going to www.osphena.com. Yes. You may get your savings via a rebate check; in order to receive your check, please provide the following information: The privacy of your healthcare information is important to us, please visit www.osphena.com for full Privacy Policy The 11-digit ID# and GRP# that is found on the Osphena offer or a photocopy of the offer. A proof of purchase (original pharmacy receipt with pharmacy name, product name, prescription number or Rx#, date filled, quantity, and Page 8 of 10
8. What is the mailing address for reimbursement? 9. How long after the Program expires can I still mail in for a manual reimbursement? Customer Service 1. How do I download a Savings Card from the website? Page 9 of 10 the price) Your name, address, city, state, zip, phone number, DOB, and the out of pocket payment Mail all of this information to: Osphena Claims Processing Dept. PO BOX 7017 BEDMINSTER, NJ 07921-7017 Osphena Claims Processing Dept. PO BOX 7017 BEDMINSTER, NJ 07921-7017 We will process manual reimbursement requests with a fill date on or before the program expiration date of December 31, 2015. Shionogi Inc. reserves the right to discontinue or modify the program at any time. From the Osphena Savings Program page on www.osphena.com, simply follow these steps. 1. Answer the two eligibility questions. 2. If determined eligible, provide your name and email address. 3. Click the "Create My Savings Card" button. 4. On the next screen, there is a button for you to View and Print your Osphena Savings Offer and Full Prescribing Information. Click this button to generate your Offer. 5. You will also be sent an email with a link to your Osphena Savings Offer, in case you'd like to print it at a later time. This email will contain a link you'll need to click, which will take you to an Osphena Savings offer that will include your unique ID number. Please note that printing the
2. I have experienced an adverse event or have a product complaint. 3. Is there a help desk for additional inquiries about the Program? 4. Where can I find more information about Osphena? email itself that has an image of an example Savings offer will not work at the pharmacy, as it will not have your unique ID number. In case of a serious adverse event dial 911, or contact your healthcare physician immediately. To report an adverse event and/or product complaint, please call the Shionogi Medical Information line at 800-849- 9707 Yes. Patients can call 1-855-285-8108 anytime for answers to questions. Pharmacists can call 1-800-422-5604, Monday through Friday from 8:30am-10:00pm EST, Saturday from 9:00am-8:00pm EST, and Sunday from 10:00am-8:00pm Eastern Time. You can visit www.osphena.com or call 855.OSPHENA. 2015 Shionogi Inc. Florham Park, NJ 07932. All Rights Reserved. Osphena is a registered trademark of Shionogi & Co., Ltd. Osaka, Japan. OSP15-WWW-015-01 04/15 Page 10 of 10