Copay savings program
Program Terms and Conditions
- Provides copay/coinsurance support for eligible patients with private commercial insurance only.*
- Program covers up to $500 of out-of-pocket copay/coinsurance costs after the patient has paid the first $50 of their required copay/coinsurance amount.
- Copay/coinsurance support is available to cover patient out-of-pocket costs associated with treatments of ORBACTIV® administered in a physician practice based infusion clinic, hospital outpatient setting or home infusion. The program is not available for treatments of ORBACTIV® administered in the inpatient hospital setting of care.
- The program does not cover any deductible amounts that may be owed by a patient.
Explanation of Payment document must be submitted to 1-844-ORBACTIV to demonstrate patient eligibility.
*Patients must be United States residents and be 18 years of age or older. Eligible patients must have a minimum of a $50 copayment or coinsurance obligation for ORBACTIV®. Patients will be granted up to $500 of copay savings funds and must contribute $50 toward their copay or coinsurance. The Program does not cover deductible, premium, or other amounts that are not exclusively stated as copayment or coinsurance. Patients who pay cash or who are enrolled in or participate in any type of government insurance or reimbursement programs, including but not limited to Medicare, Medicaid, including managed Medicaid, Tricare, and FEHP, are not eligible. As a condition precedent of the copayment or coinsurance support provided under this program, e.g., copay or coinsurance amounts paid to administering providers, participating patients and administering providers are obligated to inform insurance companies and third-party payors of any benefits they receive and the value of this program, as required by contract or otherwise. Void where prohibited by law, taxed, or restricted. Additional terms and conditions may apply. Patients enrolled in the ORBACTIV® Patient Assistance Program are not eligible. Melinta Therapeutics, Inc. may determine eligibility, monitor participation, and modify or discontinue any aspect of this program at any time. For additional information regarding ORBACTIV®, including Important Safety Information, please see the Full Prescribing Information available at www.orbactiv.com.