Patient Instructions: By using this offer, you are certifying that you meet the eligibility criteria and will comply with the terms and conditions described in the Restrictions section. You may not be enrolled in a state or federally funded prescription benefit program, including, but not limited to, Medicare, Medicaid, Veterans Affairs (VA), Department of Defense (DOD), or TRICARE.  In order to redeem this offer you must have a valid prescription for Padagis Lenalidomide Capsules, you must have commercial insurance, and you must not be a resident of Massachusetts or California. Patients may pay as little as $0 out of pocket per fill. Maximum program benefits apply, including maximum per-prescription fill benefit of $250 and maximum annual program benefit. Patient is responsible for costs above maximum benefit amounts.  Program not valid for Non-Insured/Cash-Paying Patients or where Padagis’ Lenalidomide Capsules are not covered by the primary insurance. Follow the dosage instructions given by the doctor. This offer may not be redeemed for cash. THIS IS NOT AN INSURANCE PROGRAM and is not a substitute for insurance. Patients with questions about the offer, including maximum limits and benefits, should call (833) 427-5605.

Pharmacist: This offer is eligible only for Padagis Lenalidomide Capsule products with the following NDCs: 2.5 mg (NDC 0574-1402-28), 5 mg (NDC 0574-1405-28), 10 mg (NDC 0574-1410-28), 15 mg (NDC 0574-1415-21), 20 mg (NDC 0574-1420-21) and 25 mg (NDC 0574-1425-21). When you apply this offer, you are certifying that you have not submitted a claim for reimbursement under any federal, state, or other governmental programs for this prescription and will not seek reimbursement from health insurance or any third party for any part of the benefit the patient receives through this program. Participation in this program must comply with all applicable laws and regulations as a pharmacy provider. By participating in this program, you are certifying that you will comply with the terms and conditions described in the Restrictions section below.

Pharmacist Instructions for Insured Patients: Commercially insured patients may pay a copay as low as $0 for you out-of-pocket per prescription fills for Padagis Lenalidomide Capsules. Patient is responsible for costs above maximum per fill amount of $250. Submit the claim to the primary Third Party Payer first, then submit the balance due to Change Healthcare as a Secondary Payer COB [coordination of benefits] with patient responsibility amount and a valid Other Coverage Code, (e.g. 8).  Reimbursement will be received from Change Healthcare.

Restrictions: This offer is valid only in the United States. Patients are not eligible if they have prescription insurance coverage through Medicaid, a Medicare drug benefit plan, Veterans Affairs (VA) or Department of Defense (DoD), TRICARE or other federal or state health programs (such as medical assistance programs). If the patient is eligible for drug benefits under any such program or is Medicare eligible and enrolled in employer-sponsored group waiver health plans or government-subsidized prescription drug benefit programs for retirees, the patient cannot use this offer. Offer not available to or valid for Massachusetts residents or California residents. Patients must have commercial insurance. Offer not valid for uninsured patients.  By using this offer, the patient and pharmacist certify that they will comply with any terms or requirements imposed on patients or providers by the health insurance to notify the health insurance plan of the existence and/or value of this offer. Offer not valid for patients under 18 years of age. It is illegal to (or offer to) sell, purchase, or trade this offer. This offer is not transferable and is limited to one offer per person. Not valid if reproduced. Void where prohibited by law. THIS IS NOT INSURANCE. Program managed by PSKW, LLC d/b/a ConnectiveRx on behalf Padagis US LLC. Padagis reserves the right to rescind, revoke or amend this offer without notice at any time.

Please see Full Prescribing Information, including Boxed WARNING and Medication Guide