Terms and Conditions

ELIQUIS Direct-to-Patient Program (the “Program”) Terms and Conditions

Please see U.S. Full Prescribing Information, including Boxed WARNINGS and Medication Guide.

In order to participate in this Program, a patient must:

• Be 18 years of age or older
• Have a valid prescription for ELIQUIS for an FDA-approved indication
• Be a resident of the United States, Puerto Rico, or other select U.S. Territory
• Be uninsured, have insurance that does not cover ELIQUIS, or have higher out-of-pocket expenses for ELIQUIS through their insurance than under the Program
• Not be enrolled in a Medicare Part D or a Medicare Advantage prescription drug plan
• Contact the ELIQUIS 360 Patient Support Program for an assessment of their prescription drug coverage for ELIQUIS

Patients may participate in this Program if they are uninsured or have insurance that does not cover ELIQUIS, or if the cash price for ELIQUIS through this Program is lower than their out-of-pocket expenses using insurance. Patients participating in Medicare Part D or a Medicare Advantage prescription drug plan are not eligible to participate in this Program. If the patient has insurance and fulfills their prescription through this Program, the transaction will process outside of any insurance. Patient payments will not count toward any deductibles and cannot be applied to a patient’s maximum out-of-pocket costs. Patients and prescribers cannot seek reimbursement, from health insurance or any third party, for any medication received by the patient through this Program.

Bristol Myers Squibb and Pfizer reserve the right to rescind, revoke, or amend this Program and the cash price for ELIQUIS under this Program at any time without notice.

Reconfirmation of patient information may be requested periodically to ensure accuracy of data and compliance with terms. Patients with questions about the Program may call 1-855-ELIQUIS (354-7847), Monday–Friday, 8 AM–8 PM (ET). This Program is not insurance. This Program is not conditioned on any past, present, or future purchase, including refills of ELIQUIS. This Program cannot be combined with any other coupon, free trial, discount, prescription savings card, or other Program not associated with this Program.

This Program is valid only in the United States and its territories, unless prohibited by law. There are no membership fees. By using this program, you certify that you meet the eligibility criteria and will comply with the terms and conditions described herein and will not seek reimbursement for any medication received through this Program.

By using this program, you certify that you meet the eligibility criteria and will comply with the terms and conditions described herein and will not seek reimbursement for any medication received through this Program.

Program Details

The ELIQUIS Direct-to-Patient Program utilizes a cash-pay pharmacy, and insurance is not accepted. These cash prescriptions are filled by CoverMyMeds and CoverMyMeds Patient Direct Pharmacy.

Patients enrolled in the Program can pay as follows:

Patient is responsible for applicable taxes, if any. Patients must provide payment prior to dispense and shipment of their prescription.

Disclosure of Third-Party Service Providers

Cencora: A patient solutions provider supporting the ELIQUIS 360 Patient Support Program. Cencora manages patient intake, eligibility, outreach, and offers live support to enrolled patients. Contact ELIQUIS 360 to evaluate your eligibility for the Program.

CoverMyMeds (CMM) and CMM Patient Direct Pharmacy: ELIQUIS Direct-to-Patient dispensing pharmacy responsible for patient accounts, payment collection, medication fulfillment, tracking, and shipping.

By using this service, you consent to have your prescription(s) processed and dispensed by pharmacies affiliated with CMM Patient Direct operating under a shared services arrangement, where permitted. You understand that processing and dispensing your prescription may involve the transfer of your prescription to pharmacies within the CoverMyMeds Pharmacy network for the purpose of fulfilling your prescription.