Savings Offer Terms.
With the DYANAVEL®
XR (amphetamine) Savings Card, eligible commercially-insured and cash-paying patients can lower their out-of- pocket costs for DYANAVEL®
XR prescriptions. After activation, insured patients may pay as little as $0 for their first prescription, and the card pays up to the maximum benefit. On subsequent uses, patients may pay as little as $20, and the card pays up to the maximum benefit. Cash-paying patients are responsible for the first $50, and the card pays up to the maximum benefit
. Program benefit calculated on FDA-approved dosing. Offer valid for up to 6 uses within the 2019 calendar year. A valid Prescriber ID# is required on the prescription.
Please click here
for Full Prescribing Information, including Boxed Warning regarding Abuse and Dependence.
This program is valid from 01/1/2019 through 06/30/2019.
Patients with questions about the DYANAVEL XR Savings offer should call 1-844-865-8684.
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. 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 a patient with an Eligible Third Party:
Submit the claim to the primary Third Party Payer first, then submit the balance due to Therapy First Plus
as a Secondary Payer as a copay only billing using a valid Other Coverage Code, (e.g. 8, 3)
. On the 1st use, the patient is responsible for $0 and the card pays up to the maximum benefit. On uses 2-12, the patient may pay as little as $20 and the card pays up to the maximum benefit. Reimbursement will be received from Therapy First Plus
Pharmacist instructions for a cash-paying patient:
Submit this claim to Therapy First Plus
. A valid Other Coverage Code (e.g. 1)
is required. The patient is responsible for first $50 and the card pays up to the maximum benefit. Reimbursement will be received from Therapy First Plus.
For any questions regarding Therapy First Plus
online processing, please call the Help Desk at 1-800-422-5604.
This offer is valid in the United States. Offer not valid for prescriptions reimbursed in whole or in part under Medicaid, a Medicare drug benefit plan, 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, the patient cannot use this offer. By using this offer, the patient certifies that he or she will comply with any terms of his or her health insurance contract requiring notification to his or her payer of the existence and/or value of this offer. It is illegal to (or offer to) sell, purchase, or trade this offer. Program expires 06/30/2019
. This offer is not transferable and is limited to one offer per person. Not valid if reproduced. Void where prohibited by law. Program managed by PSKW, LLC. on behalf of Tris Pharma. Tris Pharma reserves the right to rescind, revoke, or amend this offer without notice at any time.
DYANAVEL is a registered trademark of Tris Pharma, Inc. © 2019 Tris Pharma, Inc. All rights reserved.