Patients may be eligible to receive up to twelve 30-day fills at no charge where coverage is not available until the insurer has established a coverage review process. If at any time a patient begins receiving prescription drug coverage under any such federal, state, or government-funded healthcare program, the patient will no longer be able to use the QULIPTA Complete Savings Card, and the patient must call 1.855.QULIPTA to stop participation. The program is not available to cash-paying patients or patients receiving prescription reimbursement under any federal, state, or government-funded insurance programs (for example, Medicare, Medicare Advantage, Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs programs) or where prohibited by law or by the patient’s health insurance provider. The eligibility criteria varies by the form of copay assistance provided and will be made available to you as part of the enrollment process for the form or forms that you apply to receive. Eligibility: Available to patients with commercial prescription insurance coverage for QULIPTA who meet eligibility criteria. Eligible patients will receive copay assistance through one or more forms, such as a savings or copay card, and enrollment requirements may vary. This benefit covers QULIPTA™ (atogepant). Restrictions, including monthly maximums, may apply. Offer subject to change or discontinuance without notice.

Patients may not seek reimbursement for value received from QULIPTA Patient Savings Program, including the copay card, from any third-party payers. Patients residing in or receiving treatment in certain states may not be eligible. If at any time a patient begins receiving prescription drug coverage under any such federal, state, or government-funded healthcare program, patient will no longer be able to use the QULIPTA Patient Savings Program Card and patient must call QULIPTA at 1-800-QULIPTA and stop use of the copay card.

Copay assistance program is not available to patients receiving prescription reimbursement under any federal, state, or government-funded insurance programs (for example, Medicare, Medicare Advantage, Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs programs) or where prohibited by law or by the patient’s health insurance provider.

Copay card