The Co-pay Assistance Program is not valid for uninsured patients. The Co-pay Assistance Program is not valid for patients covered under Medicaid (including Medicaid patients enrolled in a qualified health plan purchased through a health insurance exchange established by a state government or the federal government), Medicare, a Medicare Part D or Medicare Advantage plan (regardless of whether a specific prescription is covered), TRICARE, CHAMPUS, Puerto Rico Government Health Insurance Plan (“Healthcare Reform”), or any other state or federal medical or pharmaceutical benefit program or pharmaceutical assistance program (collectively, “Government Programs”).Patient must have private health insurance that provides coverage for the cost of the Program Product under a medical benefit plan.Patient must be prescribed the Program Product for an FDA-approved indication.To receive benefits under the Organon Co-pay Assistance Program (“Co-pay Assistance Program”) for RENFLEXIS (“Program Product”), the patient must enroll in the Co-pay Assistance Program and be accepted as eligible.Terms and Conditions – RENFLEXIS – (Medical Benefit): Both sets of Terms and Conditions for the Co-pay Assistance Program for RENFLEXIS are set forth below. The Organon Co-pay Assistance Program ("Co-pay Assistance Program") for RENFLEXIS consists of two sets of Terms and Conditions, one applicable to RENFLEXIS for which a claim is submitted by a patient’s health care provider (“Medical Benefit”) and the other applicable to RENFLEXIS purchased by a patient at a participating pharmacy (“Pharmacy Benefit”).
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