aThe initial dose of Adbry may be shipped either to your home or your healthcare provider office, after submission of a completed Enrollment and Prescription Form. A Nurse Advocate must coordinate shipment to a patient, which may extend delivery time. Patients who have been initiated on therapy with samples are not eligible for Rapid Access product.
bAdditional terms, conditions and eligibility rules apply. Enrollment in Adbry™ Advocate™ is not required to obtain copay support. For all other patient support programs, submission of a completed Enrollment and Prescription Form is required. Patient may not seek reimbursement for the benefit received from any party. LEO Pharma reserves the right to rescind, revoke or amend the Program and discontinue support at any time without notice.
cPatient is not eligible for the Program if enrolled in any federally or state funded health care program, including but not limited to Medicare (including Medicare Part D), Medicaid, VA, DOD, TRICARE or CHIP.
*Program has an annual cap. Program may not be combined with any third-party rebate, coupon or offer.
dIncome eligibility requirements apply. Patient may be required to submit documentation of income and insurance coverage status.