Co-pay Assistance Program
Somerset Pharma is committed to providing access to high-quality medications to US patients. To alleviate the burden of drug pricing, Somerset’s Copay Assistance Program may be able to help. Commercially insured patients and eligible cash paying patients may pay as little as $0 out-of-pocket on select Somerset Pharma products. Program maximum limits apply.*
Somerset’s Copay Assistance Program is valid for the following National Drug Codes:
| National Drug Codes (NDC) | Product |
| 70069-837-01 | Eltrombopag Tablets, 12.5MG |
| 70069-838-01 | Eltrombopag Tablets, 25MG |
| 70069-839-01 | Eltrombopag Tablets, 50MG |
| 70069-840-01 | Eltrombopag Tablets, 75MG |
| 70069-848-30 | Rilpivirine Tablets 25MG |
| 70069-842-01 | Tofacitinib IR Tablets, 10mg |
| 70069-841-01 | Tofacitinib IR Tablets, 5mg |
Patient Instructions:
- Download or print the digital savings card and present it at your pharmacy along with a valid prescription.
- Eligible cash paying and commercially insured patients may receive their monthly prescription for $0*.
- For pharmacy processing questions, please contact:
| Contact | Phone | Hours of Operation |
|---|---|---|
| Pharmacy Help Desk (Operated by PDMI) | (330) 259 – 0742 | 24 hours / day 365 days / year |
By using this offer, you acknowledge that you meet the Eligibility Criteria and will comply with the Terms & Conditions.
Eligibility Criteria and Terms & Conditions
All patients are eligible for this program savings if they present a valid prescription for any eligible Somerset product listed above and the claim is processed through commercial insurance or paid for with cash. If other third-party reimbursement covers a portion of your prescription, this coupon is valid only for your actual out-of-pocket expenses, up to the maximum benefit allowed per this program. This program is not valid for prescriptions reimbursed under Medicare, Medicaid, CHAMPUS, VA, DOD, TRICARE, or any other federal or state program, or where prohibited by law. This offer is not insurance and is only valid for prescriptions filled in the United States and its territories. Somerset Pharma LLC reserves the right to rescind, revoke, or amend this program without notice. The selling, purchasing, trading, or counterfeiting of this card is prohibited by law. Digital scans or printouts of this card is non-transferable and has no cash value. Contact the Pharmacy Help Desk for more information on maximum limits, assistance, and benefits.