TERMS AND CONDITIONS
xhance preferred pharmacy network
COMMERCIALLY INSURED PATIENTS WITH COVERAGE FOR XHANCE
- Eligible commercially insured patients (other than High Deductible Patients) who have coverage for XHANCE (“Covered Patients”) and fill their prescription through the XHANCE Preferred Pharmacy Network (“PPN”) may receive their initial prescription of XHANCE (up to a 90-day supply) for an out-of-pocket cost of as little as $0, and may receive their refills of XHANCE (up to a 90-day supply) for an out-of-pocket cost of as little as $25.
- Covered Patients who fill their prescription through the XHANCE PPN, and are validly enrolled in a qualifying refill program through certain participating XHANCE PPN pharmacies, may receive their prescription of XHANCE (up to a 90-day supply) for an out-of-pocket cost of as little as $0.
- Eligible commercially insured patients who have coverage for XHANCE where they are responsible for a high patient cost share (“High Deductible Patients”) and fill their prescription through certain participating XHANCE PPN pharmacies may receive their prescription of XHANCE (up to 2 units) for an out-of-pocket cost of as little as $99 per unit. For clarity, High Deductible Patients may not be eligible for the offers specified above.
COMMERCIALLY INSURED PATIENTS WITHOUT COVERAGE FOR XHANCE
- Eligible commercially insured patients who do not have coverage for XHANCE (“Not Covered Patients”) and fill their prescription through the XHANCE PPN may receive their prescription of XHANCE for an out-of-pocket cost of as little as $99 per unit (up to 2 units).
- Not Covered Patients who do not have coverage for XHANCE due to a requirement from their insurance provider for a prior authorization, and fill their prescription through the XHANCE PPN, may receive their initial prescription of XHANCE for an out-of-pocket cost of as little as $0 (maximum units apply).
CASH-PAYING PATIENTS
- Offers to purchase XHANCE may be available to eligible cash-paying patients (patients acquiring XHANCE not through insurance) through certain participating XHANCE PPN pharmacies.
RETAIL PHARMACIES
COMMERCIALLY INSURED PATIENTS WITH COVERAGE FOR XHANCE
- Covered Patients who fill their prescription through a retail pharmacy utilizing the XHANCE copay card may receive their initial prescription of XHANCE (up to a 90-day supply) for an out-of-pocket cost of as little as $0, and may receive their refills of XHANCE (up to a 90-day supply) for an out-of-pocket cost of as little as $25.
- High Deductible Patients who fill their prescription through a retail pharmacy utilizing the XHANCE copay card may receive their prescription of XHANCE (up to 2 units) for an out-of-pocket cost of as little as $99 per unit.
- Not Covered Patients who fill their prescription through a retail pharmacy utilizing the XHANCE copay card may receive their prescription of XHANCE for an out-of-pocket cost of as little as $99 per unit (up to 2 units).
GENERAL TERMS AND CONDITIONS
- All copay support offers are subject to an annual maximum benefit of $6,000 per patient.
- All copay support offers are subject to maximum benefits per unit.
- Patient cost share, including enrollment in a high-deductible plan, may impact benefits and eligibility, or may result in additional limitations, such as different quantity limits.
- 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 these offers. 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 these offers even if you elect to be processed as an uninsured (cash-paying) patient.
- Copay support paid by these programs to reduce a patient’s out-of-pocket costs 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), and may be required to be reported by the patient to its insurance provider.
- 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 prescriptions costs paid or reimbursed entirely by health benefit programs. Cash discount cards are not commercial payers and are not eligible to be used in conjunction with this program.
- 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.
- Optinose reserves the right to rescind, revoke, or amend these offers and terms and conditions of use at any time without notice.
- By accepting any of these offers or using the XHANCE copay card, the patient authorizes the transfer of their XHANCE prescription to any pharmacy within the XHANCE PPN.
Patients may call 1-833-4XHANCE to be connected to a pharmacy participating in the XHANCE Preferred Pharmacy Network and for other offers that may be available.
Last updated: January 2024.
Indications
XHANCE is a prescription medicine used to treat chronic rhinosinusitis with or without nasal polyps in adults. It is not known if XHANCE is safe and effective in children.
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.
- XHANCE can cause nasal problems such as nosebleeds, crusting, sores, hole in the septum, and slow wound healing. You should not use XHANCE until your nose has healed if you have a sore on your nose, have had surgery on your nose, or if your nose is injured.
- XHANCE can cause eye problems including glaucoma and cataracts. You should have regular eye exams when using XHANCE. Call your doctor if you have vision changes while 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).
- The most common side effects include: nose bleeds, sores (ulcers) in your nose, pain or swelling of your nose or throat, redness in your nose, nasal congestion, sinus infection and headache.
- 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.
These are not all the side effects of XHANCE. Call your doctor for medical advice about side effects. You are encouraged to report negative side effects of prescription drugs to the FDA at www.fda.gov/medwatch or call 1-800-FDA-1088.
Please see Patient Information, full Prescribing Information and Instructions for Use.
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