VALUE SAVINGS FOR
YOUR
PRESCRIPTIONS
Simply activate your Ortho Dermatologics Access coupon and take it to Walgreens or a participating independent pharmacy to pick up your prescription.
COMMERCIALLY INSURED DRUG COVERED
WHEN DEDUCTIBLE IS METMOST ELIGIBLE COMMERCIALLY INSURED PATIENTS WILL PAY AS LITTLE AS A
Limitations apply. See table below for pricing and maximum number of fills allowed.
COMMERCIALLY INSURED DRUG NOT
COVERED OR CASH PAY†
MOST ELIGIBLE COMMERCIALLY INSURED PATIENTS, WHEN DRUG IS NOT COVERED,
WILL PAY AS LITTLE AS A
Limitations apply. See table below for pricing and maximum number of fills allowed.
If your deductible co-pay is too much,
ask your pharmacist for the $65 cash pay option.
*After the indicated number of fills, patient will pay uninsured amount for any remaining fills available. If prior authorization
is approved, patient will pay the covered amount listed below. Please see below for terms and conditions.
is approved, patient will pay the covered amount listed below. Please see below for terms and conditions.
†Insured not covered is defined as a patient who has commercial insurance but the drug is not covered on the plan’s formulary or has an NDC block, prior authorization, step edit or other restriction that has not been met.
SAVINGS FOR ELIGIBLE PATIENTS
| Product Name | Size | Drug Covered Co-Pay |
Drug Covered Fills |
Drug Not Covered Co-Pay or Cash Pay |
Drug Not Covered Fills§ |
|---|---|---|---|---|---|
| ARAZLO® (tazarotene) Lotion. 0.045% | 45 g | $0 | 6 | $65 | 6 |
| BRYHALI® (halobetasol) Lotion, 0.01% | 60 g 100 g |
$25 | 6 | $65 | 6 |
| CLINDAGEL® (clindamycin phosphate gel) Topical Gel, 1% | 75 mL | $25 | 6 | $65 | 2 |
| DUOBRII® (halobetasol propionate and tazarotene) Lotion, 0.01%/0.045% | 100 g | $25 | 6 | $65 | 6 |
| JUBLIA®(efinaconazole) Topical Solution 10% | 4 mL 8 mL |
$0 | 12 | $65 $130 |
12 |
| LUZU® (luliconazole) Cream, 1% | 60 g | $25 | 6 | N/A | N/A |
| NORITATE® (metronidazole) Cream, 1% | 60 g | $25 | 6 | N/A | N/A |
| ONEXTON® (clindamycin phosphate and benzoyl peroxide) Gel, 1.2% / 3.75% | 50 g | $25 | 6 | $65 | 2 |
| RETIN-A MICRO® (tretinoin) Gel Microsphere 0.08% / 0.06% | 50 g | $25 | 6 | $65 | 2 |
| ZIANA® (clindamycin phosphate 1.2% and tretinoin 0.025%) Gel | 30 g 60 g |
$25 | 6 | N/A | N/A |
| ZOVIRAX® (acyclovir) Cream 5% | 5 g | $25 | 6 | N/A | N/A |
ARAZLO® (tazarotene) Lotion. 0.045%
| Size | 45 g |
| Drug Covered Co-Pay | $0 |
| Drug Covered Fills | 6 |
| Drug Not Covered Co-Pay or Cash Pay | $65 |
| Drug Not Covered Fills§ | 6 |
BRYHALI® (halobetasol) Lotion, 0.01%
| Size | 60 g/100 g |
| Drug Covered Co-Pay | $25 |
| Drug Covered Fills | 6 |
| Drug Not Covered Co-Pay or Cash Pay | $65 |
| Drug Not Covered Fills§ | 6 |
CLINDAGEL®(clindamycin phosphate gel) Topical Gel, 1%
| Size | 75 mL |
| Drug Covered Co-Pay | $25 |
| Drug Covered Fills | 6 |
| Drug Not Covered Co-Pay or Cash Pay | $65 |
| Drug Not Covered Fills§ | 2 |
DUOBRII®(halobetasol propionate and tazarotene) Lotion, 0.01%/0.045%
| Size | 100 g |
| Drug Covered Co-Pay | $25 |
| Drug Covered Fills | 6 |
| Drug Not Covered Co-Pay or Cash Pay | $65 |
| Drug Not Covered Fills§ | 6 |
JUBLIA®(efinaconazole) Topical Solution 10%
| Size | 4 mL/8 mL |
| Drug Covered Co-Pay | $0 |
| Drug Covered Fills | 12 |
| Drug Not Covered Co-Pay or Cash Pay | $65 $130 |
| Drug Not Covered Fills§ | 12 |
LUZU®(luliconazole) Cream, 1%
| Size | 60 g |
| Drug Covered Co-Pay | $25 |
| Drug Covered Fills | 6 |
| Drug Not Covered Co-Pay or Cash Pay | N/A |
| Drug Not Covered Fills§ | N/A |
NORITATE®(metronidazole) Cream, 1%
| Size | 60 g |
| Drug Covered Co-Pay | $25 |
| Drug Covered Fills | 6 |
| Drug Not Covered Co-Pay or Cash Pay | N/A |
| Drug Not Covered Fills§ | N/A |
ONEXTON®(clindamycin phosphate and benzoyl peroxide) Gel, 1.2% / 3.75%
| Size | 50 g |
| Drug Covered Co-Pay | $25 |
| Drug Covered Fills | 6 |
| Drug Not Covered Co-Pay or Cash Pay | $65 |
| Drug Not Covered Fills§ | 2 |
RETIN-A MICRO®(tretinoin) Gel Microsphere 0.08% / 0.06%
| Size | 50 g |
| Drug Covered Co-Pay | $25 |
| Drug Covered Fills | 6 |
| Drug Not Covered Co-Pay or Cash Pay | $65 |
| Drug Not Covered Fills§ | 2 |
ZIANA®(clindamycin phosphate 1.2% and tretinoin 0.025%) Gel
| Size | 30 g/60 g |
| Drug Covered Co-Pay | $25 |
| Drug Covered Fills | 6 |
| Drug Not Covered Co-Pay or Cash Pay | N/A |
| Drug Not Covered Fills§ | N/A |
ZOVIRAX®(acyclovir) Cream 5%
| Size | 5 g |
| Drug Covered Co-Pay | $25 |
| Drug Covered Fills | 6 |
| Drug Not Covered Co-Pay or Cash Pay | N/A |
| Drug Not Covered Fills§ | N/A |
§After the indicated number of fills, patient will pay uninsured amount for any remaining fills available.
If prior authorization is approved, patient will pay the covered co-pay price listed.
If prior authorization is approved, patient will pay the covered co-pay price listed.
Eligibility Criteria/Terms and Conditions:
By using the Ortho Dermatologics Access coupon, you confirm that you understand and agree to comply with the following terms and conditions of this offer:
- This offer is only valid for patients with commercial insurance and uninsured cash-pay patients.
- This offer is not valid for any person eligible for reimbursement of prescriptions, in whole or in part, by any federal, state, or other governmental programs, including, but not limited to, Medicare (including Medicare Advantage and Part A, B, and D plans), Medicaid, TRICARE, Veterans Administration or Department of Defense health coverage, CHAMPUS, the Puerto Rico Government Health Insurance Plan, or any other federal or state health care programs.
- You agree not to seek reimbursement for all or any part of the benefit received through this offer and are responsible for making any required reports of your use of this offer to any insurer or other third party who pays any part of the prescription filled.
- This offer is good only in the United States of America (including the District of Columbia, Puerto Rico and the U.S. Virgin Islands) at retail pharmacies owned and operated by Walgreen Co. (or its affiliates) and other participating independent retail pharmacies. This offer is not valid in Massachusetts or Minnesota or where otherwise prohibited, taxed, or otherwise restricted. This offer is not valid for redemption in the State of California or by any resident of the State of California with regard to any product for which a therapeutically equivalent generic product is available, including ZIANA® gel.
- This offer is not valid for any person that is 65 years of age or older without commercial insurance. You must be 18 years of age or older to redeem this offer for yourself or a minor.
- You must present this coupon along with your prescription to participate in this program. You must activate this coupon before using by calling 1-855-202-3279, texting "RXSAVE" to 26729, or by visiting https://copaysavingsprogram.com/110/ortho-dermatologics.
- This coupon is good for use only with the products identified herein.
- No other purchase is necessary.
- This offer cannot be redeemed at government-subsidized clinics.
- This coupon is good for a limited number of fills only. For a complete listing of the maximum number of fills for each product for which this offer applies, please review the program terms and conditions, which are posted at www.orthorxaccess.com.
- Reimbursement limitations apply. Patient is responsible for all additional costs and expenses after reimbursement limits are reached.
- This coupon and offer are not health insurance.
- The selling, purchasing, trading, or counterfeiting of this coupon is prohibited by law. Void if reproduced.
- This offer is not valid with other offers. This coupon has no cash value. No cash back.
- Ortho Dermatologics' affiliated entities reserve the right to rescind, revoke, terminate, or amend this offer at any time, without notice.
- You understand and agree to comply with the terms and conditions of this offer as set forth above and at www.orthorxaccess.com.
- For questions call: 1-855-202-3279.