*Program has an annual cap. Program may not be combined with any third-party rebate, coupon, or offer.
aThe initial dose of Adbry may be shipped either to your office or to the patient after submission of a completed Enrollment and Prescription Form or annual Healthcare Provider eRx Program Certification Form, as applicable, and Patient Authorization. A Case Manager 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, enrollment in Adbry® Advocate® is required. Patient or healthcare provider 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 healthcare program, including but not limited to Medicare (including Medicare Part D), Medicaid, VA, DOD, TRICARE, or CHIP.
dIncome eligibility requirements apply. Patient may be required to submit documentation of income and insurance coverage status.