Terms, Conditions, and Eligibility Requirements: Eligible patients must have commercial prescription insurance with coverage for Teva’s Teriparatide Injection, USP. Uninsured and cash-paying patients are NOT eligible for this Program. Patients enrolled in any state or federally funded healthcare program, including but not limited to, Medicare, Medigap, Medicaid, VA, DOD, TRICARE, Puerto Rico Government Health Insurance Plan, Medicare-eligible patients enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees, are NOT eligible for this Program. Cash Discount Cards and other noninsurance plans are not valid as primary under this Program. This Program is restricted to residents of the United States and United States territories.
Patients may pay as little as $0 out of pocket for Teva’s Teriparatide Injection, USP. Maximum Program assistance per prescription and annual benefits apply and out-of-pocket expenses may vary. Patient is responsible for costs above maximum benefit amounts. This Program is not insurance. Void if copied, transferred, purchased, altered, or traded and where prohibited and restricted by law. The Program is not transferable. No substitutions are permitted. The Program form may not be sold, purchased, traded, or counterfeited. Void if reproduced. The Program benefit cannot be combined with any other financial assistance program, free trial, discount, prescription savings card, or other offer. This Program is managed by Mercalis on behalf of Teva Pharmaceuticals USA, Inc. Teva Pharmaceuticals USA, Inc. and its affiliates reserves the right to make eligibility determinations, to set Program benefit maximums, to monitor participation, and to change, rescind, revoke, or discontinue this Program at any time without notice. Limit one Program enrollment per individual. If you have any questions regarding this Program, your eligibility or benefits, or if you wish to discontinue your participation, please call 844-248-7949. Expiration Date: 12/31/2025.
The Copay Card is intended for the benefit of patients, not their insurance plans or other third parties. Patients whose commercial insurance plans do not apply Copay Card payments to satisfy patient out-of-pocket cost sharing amounts may not be eligible for the Copay Card. Similarly, patients whose commercial insurance plans require use of the Copay Card as a condition of the plan waiving some or all of otherwise applicable patient out-of-pocket cost sharing amounts may not be eligible for the Copay Card or have a reduced annual maximum program benefit. If you believe your commercial insurance plan may have such limitations, please call 844-248-7949.
Valid only for Teva’s Teriparatide Injection, USP, National Drug Code: 00093-1106-16
To the Patient: By redeeming this Program, you acknowledge that you are an Eligible Patient and you understand and agree to comply with the terms and conditions of this Program.
This Program is for eligible Commercially Insured Patients only. Patients may pay as little as $0 out of pocket for Teva’s Teriparatide Injection, USP. Maximum Program assistance per prescription and annual benefits apply and out-of-pocket expenses may vary. This Program must be presented along with your prescription for Teva’s Teriparatide Injection, USP and your primary insurance card to participate in this Program. Program not valid for Non-Insured/Cash-Paying Patients or where Teva’s Teriparatide Injection, USP is not covered by the primary insurance.
To the Pharmacist: When you apply this Program, you are certifying that Teva’s Teriparatide Injection, USP is being dispensed to an Eligible Patient in compliance with these terms and conditions and the Pharmacy has not submitted and will not submit a claim for reimbursement under any federal, state, or other governmental program for this prescription. For Commercially Insured Patients, please submit this claim to the primary Third-Party Payer first, then submit the balance due to Mercalis 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 Mercalis. For questions regarding processing, please call the Help Desk at 844-248-7949.
Possible bone cancer. During drug testing, the medicine in Teriparatide Injection caused some rats to develop a bone cancer called osteosarcoma. Studies in people have not shown that Teriparatide Injection increases your chance of getting osteosarcoma. There is little information about the chance of getting osteosarcoma in patients using Teriparatide Injection beyond 2 years.
Do not use Teriparatide injection if you:
Symptoms of a serious allergic reaction of Teriparatide Injection may include swelling of the face, lips, tongue or throat that may cause difficulty in breathing or swallowing. Call your healthcare provider right away or get emergency medical help if you get any of these symptoms.
Before you use Teriparatide Injection, tell your healthcare provider about all of your medical conditions, including if you:
Tell your healthcare provider about all the medicines you take including prescription and over-the-counter medicines, vitamins, and herbal supplements. Know the medicines you take. Keep a list of them to show your healthcare provider and pharmacist when you get a new medicine.
Teriparatide Injection may cause serious side effects including:
The most common side effects of Teriparatide Injection include pain, nausea, and joint aches. These are not all the possible side effects of Teriparatide Injection. For more information, ask your healthcare provider or pharmacist.
Call your doctor for medical advice about side effects. You are encouraged to report side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Teriparatide Injection is a prescription medicine used to:
It is not known if Teriparatide Injection is safe and effective in children. Teriparatide Injection should not be used in children and young adults whose bones are still growing.
Please read the Medication Guide in the full Prescribing Information.