Savings and support for you
and your patients

The Nurtec ODT Patient Support Program
is committed to helping your eligible
patients afford
their medication. Use the Formulary Lookup Tool to learn about coverage in your area.

Actual Nurtec ODT Patient

68% of insured lives
have coverage for
Nurtec ODT*

Savings card for Nurtec™ ODT (rimegepant) 75 mg orally disintegrating tablets

Eligible patients with commercial insurance may pay as little as
$0 per month^†

An activated copay card is included in the Patient Starter Kit. Patients can also download and activate a card to get started today via 2 easy ways:

Visit www.Nurtec.com/savings-support
Text NSAVE to 267-89^‡

This offer is invalid for patients without commercial insurance or those whose prescription claims are eligible to be reimbursed, in whole or in part, by any governmental program, including, without limitation, Medicaid, Medicare, Medicare Part D, Medigap, DOD, VA, TRICARE^®/CHAMPUS, or any state patient or pharmaceutical assistance program.

^†Per 8-tablet prescription. See Terms & Conditions.

^‡Message and data rates may apply. Patients may receive approximately 5 messages a month.
For information, including our Privacy Policy and Terms & Conditions,
please visit www.Nurtec.com/copay-terms. Once
registered,
text HELP to 267-89 for more information. Text STOP to end.

Need support with PAs?

The Nurtec ODT Patient Support Program works with CoverMyMeds to streamline the prior authorization (PA) process. Get started in three easy steps:

Complete a request

Generate a PA request required
for treatment,
or complete a pharmacy‑initiated request

Electronically submit

Click one button
to submit the request to any plan for determination

Get started now

For more information

Visit: www.covermymeds.com |

Phone: 1‑866‑452‑5017 |

Resources: go.covermymeds.com/help

^†Savings Program Terms & Conditions

Patients with commercial insurance may be able to pay as little as $0 per month. This offer is invalid for patients without commercial insurance or those whose prescription claims are eligible to be reimbursed, in whole or in part, by any governmental program, including, without limitation, Medicaid, Medicare, Medicare Part D, Medigap, DOD, VA, TRICARE^®/CHAMPUS, or any state patient or pharmaceutical assistance program. Offer void where prohibited by law and subject to change or discontinue without notice. See full Terms & Conditions for eligibility and restrictions.

Reference: 1. Nurtec ODT. Package insert. Biohaven Pharmaceuticals Inc.

Savings Program Terms & Conditions

To the Patient: In order to participate in the Nurtec ODT Patient Savings Program ("Program"), you must have a valid prescription for Nurtec™ ODT (rimegepant) orally disintegrating tablets, meet the eligibility requirements set forth herein, adhere to the terms and conditions stated in the Restrictions section below, and present this card to your pharmacist. Eligible patients with commercial insurance may pay as little as $0 out of pocket and limited to one 8‑tablet prescription per month. Patients with questions about the Program should call 1‑800‑761‑1568.

To the Pharmacist: By redeeming this offer, the Pharmacist certifies: (a) that the Pharmacy has not submitted, and will not submit, a claim for reimbursement under any federal, state, or other government programs for this prescription or where prohibited by law and (b) the Pharmacist will adhere to the terms and conditions stated in the Restrictions section below.

Pharmacist Instructions: For Commercially Insured Patients, please submit this claim to the patient's primary Third‑Party Payer first, then submit the balance due to CHANGE HEALTHCARE as a Secondary Payer COB (coordination of benefits) with patient responsibility and a valid Other Coverage Code (e.g. 08). Reimbursement will be received from CHANGE HEALTHCARE. For questions, please call the Concierge line for Nurtec ODT at 1‑800‑731‑4997, Monday – Friday, 8 am – 8 pm ET.

Restrictions: This offer is not valid for Non‑Insured/Cash-Paying Patients. This Program is not valid for prescriptions covered by or submitted for reimbursement in part or in full by any state or federally funded programs, including but not limited to Medicare, Medicaid, Medigap, VA, TRICARE (DOD). Patients with managed care restrictions (e.g., prior authorization, step edit) may not be eligible for this offer if such managed care restrictions persist. Continued eligibility may require that the patient has a prior authorization form submitted. This offer may not be used with any other financial assistance program, free trial, discount, prescription savings card or other offer. Valid only for patients 18 years and older in the United States including the Commonwealth of Puerto Rico. This Program is void if copied, transferred, purchased, altered, or traded and where prohibited by law. Limit one offer per individual. This offer expires on December 31, 2020. Biohaven Pharmaceuticals reserves the right to rescind, revoke or amend this offer without notice anytime. This Program is managed by ConnectiveRx on behalf of Biohaven Pharmaceuticals.

Savings and support for you
and your patients

Eligible patients with commercial insurance may pay as little as
$0 per month^†

Need support with PAs?

^†Savings Program Terms & Conditions

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Important Safety Information

Indication

Savings and support for you and your patients

Eligible patients with commercial insurance may pay as little as $0 per month†

Need support with PAs?

†Savings Program Terms & Conditions

< Previous Page

Important Safety Information

Indication

Savings and support for you
and your patients

Eligible patients with commercial insurance may pay as little as
$0 per month^†

^†Savings Program Terms & Conditions