TERMS, CONDITIONS, AND ELIGIBILITY
COMMERCIALLY INSURED PATIENTS
WITH COVERAGE FOR XHANCE
- Commercially insured patients who have coverage for XHANCE (covered patients) will receive their initial XHANCE 30-day prescription for an out-of-pocket cost of $0
- Covered patients who fill their prescription through the XHANCE Preferred Pharmacy Network (PPN), and are enrolled in a qualifying refill program through a participating PPN pharmacy, will receive their XHANCE refills (30-day supply) for an out-of-pocket cost of $0
- Covered patients filling their prescription through the XHANCE Preferred Pharmacy Network who do not participate in a qualifying refill program, as well as covered patients utilizing the XHANCE copay card at a retail pharmacy, will receive their XHANCE refills (30-day supply) for an out-of-pocket cost of $30 or less per unit
COMMERCIALLY INSURED PATIENTS
WITHOUT COVERAGE FOR XHANCE
- Commercially insured patients who do not have coverage (non-covered patients) for XHANCE and fill their prescription through the XHANCE Preferred Pharmacy Network will receive their initial XHANCE 30-day prescription fill for an out-of-pocket cost of $0 and will pay an out-of-pocket cost of $50 or less per unit for refills (30-day supply)
- For non-covered patients who fill their XHANCE prescription outside of the XHANCE Preferred Pharmacy Network, Optinose will pay up to the first $100 per unit when utilizing the XHANCE copay card. Patients will be responsible for the remaining balance
- Optinose will pay the first $100 per unit for cash-paying patients when utilizing the XHANCE copay card. Patients will be responsible for the remaining balance
ADDITIONAL TERMS AND CONDITIONS
- These offers are valid for patients 18 years of age or older and are good for use only with a valid prescription for XHANCE
- Patients who are enrolled in a state or federally funded prescription insurance program are not eligible for this offer. This includes patients enrolled in Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DOD) programs, or TriCare. If you are enrolled in a state or federally funded prescription insurance program, you may not use this offer even if you elect to be processed as an uninsured (cash-paying) patient
- Out-of-pocket costs paid by these programs may not be submitted as a claim for payment to any third-party payer, pharmaceutical patient assistance foundation, or account such as a Flexible Spending Account (FSA), a Health Savings Account (HSA), or a Health Reimbursement Account (HRA)
- These offers are not insurance and are restricted to residents of the United States, including Puerto Rico, at participating pharmacies. Void where prohibited by law, taxed, or restricted
- These offers are not valid for prescription costs paid or reimbursed entirely by health benefit programs. Cash discount cards and other non-insurance plans are not valid as primary under these offers
- Patient support benefits are limited to no more than 2 XHANCE units per 30-day prescription fill
- These offers and the XHANCE copay card have no cash value and may not be used in combination with any other discount, coupon, rebate, free trial, or similar offer
- Out of pocket expenses for patients filling XHANCE prescriptions outside of the XHANCE Preferred Pharmacy Network or without the use of the XHANCE copay card may vary
Eligible patients may call 1-833-XHANCE1 for other offers that may be available.
Last updated: June 2020.
Important Safety Information
- Do not use XHANCE if you are allergic to fluticasone propionate or any of the ingredients in XHANCE. Get emergency medical care if you get any of these signs of a serious allergic reaction: rash, hives, swelling of your face, mouth, and tongue, breathing problems, or low blood pressure.
- Tell your healthcare provider about all your medical conditions and medications that you take. It is especially important to mention if you take antifungal or anti-HIV medicines as they may interact with XHANCE.
- XHANCE can cause nasal problems such as nosebleeds, crusting, sores, hole in the septum, and slow wound healing.
- XHANCE can cause eye problems including glaucoma and cataracts. You should have regular eye exams when using XHANCE.
- XHANCE may increase the risk of infections and can make certain infections worse. Avoid contact with people who have a contagious disease such as chickenpox or measles while using XHANCE.
- XHANCE can cause reduced production of steroid hormones by your adrenal gland, resulting in tiredness, weakness, nausea and vomiting, and low blood pressure.
- XHANCE can weaken bones (osteoporosis).
- Other side effects may include redness, pain, or swelling of the nose or throat, thrush (fungal infection of the nose and throat), nasal congestion, sinus infection and headache.
These are not all the side effects of XHANCE. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
XHANCE is a prescription medicine used to treat nasal polyps in adults.