SECUADO Patient Assistance Program Terms and Conditions

The SECUADO_® (asenapine) transdermal system Patient Assistance Program (the “Program”) is designed to provide the product at no charge to eligible financially needy patients who are uninsured.

Eligibility Requirements

• Patients must be uninsured. Patients must not be covered in whole or in part under commercial insurance, Medicaid, Medicare, DOD, VA, TRICARE or other state or federal healthcare programs, including any state medical pharmacy assistance program.
• Patients must have been prescribed SECUADO for an FDA-approved indication.
• Patient’s income does not exceed four (4) times the Federal Poverty Level based on household size. Patients must submit accurate and complete documentation as requested by Noven or any third party administering the Program (e.g., federal tax returns, W-2, pay stubs) each year to validate levels of income.
• Patients must be a legal resident of one of the 50 United States, the District of Columbia or Puerto Rico.
• Patients must be between the ages of 18 and 64 years of age to be eligible for the Program.

Program Details

• Enrollment in the Program is for a 365-day duration from the time eligibility is determined (“Enrollment Period”). To participate in the Program for an additional Enrollment Period, patients are required to submit documentation to confirm eligibility requirements for participation in the Program are still met.
• Patients will receive a 30-day supply of the product every thirty (30) days at no charge.
• The maximum Program benefit per Enrollment Period is a 365-day supply of the product at no charge.
• Patients are eligible to participate in the Program for a maximum of three (3) Enrollment Periods.

Additional Terms and Conditions

• This Program is not insurance and does not cover or provide support for any associated supplies, procedures, or any physician-related services.
• Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any of the benefit received by the patient through this Program.
• The Program is not valid where prohibited by law.
• By participating in this Program, patients certify that they meet the eligibility criteria and will comply with these terms and conditions. If you have any questions, please call 888-526-0132, 24 hours 7 days a week or visit SECUADO.com.
• Benefits offered under this Program are non-transferable and limited to one person, and cannot be combined with any other offer or discount.
• No purchase necessary. Participation in this Program is not conditioned on any past, present or future purchase, including refills.
• Product is dispensed pursuant to Program rules, and federal and state laws.
• Noven reserves the right to rescind, revoke, terminate or amend the Program, eligibility, and terms and conditions at any time without notice.

SECUADO Bridge Program Terms and Conditions

The SECUADO® (asenapine) transdermal system Bridge Program (the “Program”) is designed to provide patient access to the product during a delay in securing commercial payer coverage for the product.

Eligibility Requirements

• Patients must have commercial prescription insurance, but the insurance plan has not yet made a coverage decision for the product. Patients appealing a denial of coverage for the product are not eligible for this Program.
• Patients must have been prescribed SECUADO for an FDA-approved indication.
• Patients must not be covered in whole or in part under Medicaid, Medicare, DOD, VA, TRICARE or other state or federal healthcare programs, including any state medical pharmacy assistance program.
• Patients must be a legal resident of one of the 50 United States, the District of Columbia or Puerto Rico.
• Patients must be between the ages of 18 and 64 years of age to be eligible for the Program.

Program Details

• Eligible patients will receive a 30-day supply of the product at no charge while pursuing a coverage decision from their insurance plan. If the patient has not received a coverage decision within 30 calendar days of receiving their initial supply, they may be eligible to receive one additional 30-day supply at no charge.
• The maximum Program benefit is a 60-day supply of the product at no charge.
• Patients may be required to submit documentation, including insurance information, verifying their eligibility for the Program.

Additional Terms and Conditions

• This Program is not insurance and does not cover or provide support for any associated supplies, procedures, or any physician-related services.
• Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any of the benefit received by the patient through this Program.
• The Program is not valid where prohibited by law or by the patient’s health insurance.
• By participating in this Program, patients certify that they meet the eligibility criteria and will comply with these terms and conditions. If you have any questions, please call 888-526-0132, 24 hours 7 days a week or visit SECUADO.com.
• Benefits offered under this Program are non-transferable and limited to one person, and cannot be combined with any other offer or discount.
• No purchase necessary. Participation in this Program is not conditioned on any past, present or future purchase, including refills.
• Product is dispensed pursuant to Program rules, and federal and state laws.
• Noven reserves the right to rescind, revoke, terminate or amend the Program, eligibility, and terms and conditions at any time without notice.

SECUADO Co-payment Assistance Program Terms and Conditions

To receive benefits under the SECUADO® (asenapine) transdermal system Co-payment Assistance Program (the “Program”), patients must be determined as eligible and be enrolled in the Program.

Eligibility Requirements

• This co-pay savings offer is only valid for commercially insured patients.
• Patients must have been prescribed SECUADO for an FDA-approved indication.
• This offer is not valid for prescriptions covered by or submitted for reimbursement in whole or in part under Medicaid, Medicare, DOD, VA, TRICARE or other state or federal healthcare programs, including any state medical pharmacy assistance program.
• This offer is valid only for legal residents of the 50 United States, the District of Columbia and Puerto Rico.
• Patients must be between the ages of 18 and 64 years of age to be eligible for the Program.

Program Details

• Enrollment in the Program is for a 365-day duration from the time eligibility is determined (“Enrollment Period”). Patients will be automatically re-enrolled in subsequent years after the initial enrollment period ends as long as the eligibility requirements for participation in the Program are still met.
• Patients may pay as little as $15 per prescription for up to 12 prescriptions. Patients may pay as little as $15 per prescription for up to 12 prescriptions. Offer is limited to a maximum benefit of $1200 per month for the first two months of eligibility and $600 per month for the remainder of the Enrollment Period. Patients will be responsible for any remaining out-of-pocket costs not covered by the Program.
• This offer is valid for up to a total of 12 prescriptions and limited to one use per month.

Additional Terms and Conditions

• This Program is not insurance and does not cover or provide support for supplies, procedures, or any physician-related services or associated payments such as deductibles, premiums or other amounts not explicitly identified as co-payments.
• Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any of the benefit received by the patient through this Program.
• The Program is not valid where prohibited by law or by the patient’s health insurance.
• By using this offer, patients certify that they meet the eligibility criteria and will comply with these terms and conditions. If you have any questions, please call 888-526-0132, 24 hours 7 days a week or visit SECUADO.com.
• Patients are responsible for reporting receipt or use of the Program to any private insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the Program, as may be required.
• Offer is non-transferable and limited to one offer per person, and cannot be combined with any other offer or discount.
• No purchase necessary. This offer is not conditioned on any past, present or future purchase, including refills.
• Product is dispensed pursuant to program rules, and federal and state laws.
• Noven reserves the right to rescind, revoke, terminate or amend this offer, eligibility, and terms and conditions at any time without notice.
• This Program is administered in part by ConnectiveRx and Asembia Specialty Pharmacy Network (ASPN).
• Aggregated and non-identifiable information from patients participating the Program may be collected, analyzed, summarized, and shared with Noven and its affiliates for market research, statistical, and other purposes related to assessing the Program.

Please read the full Prescribing Information, including BOXED WARNING, and Medication Guide for SECUADO and discuss any questions you have with a licensed healthcare practitioner.