Copay Terms and Conditions
TERMS AND CONDITIONS:
CSL Behring’s Co-Pay Programs (the “Program”) are available to new or existing patients with a valid, onlabel prescription for relevant CSL Behring products and participation in the Program is subject to these terms and conditions. To participate, you must be a resident in the United States (excluding Puerto Rico and other U.S. territories). You must also have insurance coverage for relevant CSL Behring products under a commercial health insurance plan. Patients whose insurance policy prohibits co-pay assistance are not eligible. Prior to enrolling in the Program, you are responsible for checking with your insurance carrier to confirm that your participation is not inconsistent with your insurance carrier's requirements and for satisfying any conditions imposed on your participation. Patients covered by state- or federallyfunded programs, such as Medicare, Medicaid, and Veterans Health Insurance, are NOT eligible. The Program cannot be used or combined with any other rebate/coupon, discount cards, free trial, or similar offer from CSL Behring. Co-pay assistance under the Program is for the exclusive benefit of the named patient and is nontransferable to any other person or entity. Benefits may be claimed only for product costs not covered by the patient’s commercial insurer such as: a deductible, co-payment, or coinsurance. Benefits payable under this program may not exceed the annual maximum permitted by Program rules. If you seek reimbursement on your own behalf, you must confirm that you will not submit costs paid by this Program as a claim for payment to any third-party, patient assistance foundation, or account such as a Flexible Spending Account (FSA), a Health Savings Account (HSA), or a Health Reimbursement Account (HRA). The Program only applies in the United States and does not apply where prohibited by law, taxed, or restricted. Subject to changes in state law, the Program may become invalid for residents of Massachusetts. CSL Behring reserves the right to rescind, revoke, or amend the Program at any time without notice. Additional Program restrictions may apply. Data related to a patient’s participation in the Program may be collected, analyzed, and shared with CSL Behring, for market research and other purposes related to assessing its copay assistance programs. Data shared with CSL Behring will be de-identified, meaning it will not identify you specifically.
CSL Behring allows participating patients to obtain copay assistance in one of two ways. First, the patient’s pharmacy or prescriber can request program benefits on the patient’s behalf when dispensing
the product to the patient. Second, the patient may request reimbursement with proof of payment. Further details on requesting benefits are available through contacting the Connect Programs by CSL
Behring at 888-508-6978.