Co-Pay And Reimbursement

Qbrelis is Affordable and Accessible

Backed by robust coverage and reimbursement support
  • May be eligible for reimbursement by insurance plan.
  • Reimbursed by Medicaid.
  • Dedicated Prior Authorization Hotline (1-844-472-2032).
  • Co-pay support and/or patient assistance available for qualifying patients.
 

Qbrelis Patients with Commercial Insurance May Pay No More Than $30 for a Qbrelis Prescription*

Backed by robust coverage and reimbursement support
  • Real-time savings at many pharmacies with the Qbrelis co-pay programs.
  • Automatic savings—Applies electronic coupon to co-pay.
  • Completely paperless—No physician cards or coupons needed.
  • These programs are for patients covered by commercial insurance.
Some of the participating pharmacies include:
  • Costco Pharmacy
  • CVS Pharmacy
  • Duane Reade
  • Genuardi’s Pharmacy
  • Giant Pharmacy
  • Harris Teeter
  • Kroger Pharmacy
  • Rite Aid Pharmacy
  • Sam’s Pharmacy
  • Target Pharmacy
  • Walgreens
  • Walmart Pharmacy
  • Wegmans
For eVoucherRx™ questions, please call:
800‐388‐2316 Relay Pharmacy Help Desk/Customer Support. Or you can Search Now for a list of participating pharmacies.

For Voucher On Demand™ questions, please call:
866-379-6389 Change Healthcare Help Desk/Customer Support.
 
 
For patients without commercial insurance, there are other options for gaining access to Qbrelis:
  • Qbrelis is covered by Medicaid.
  • A patient assistance program is available for those who qualify.
 

Eligibility Restrictions, Terms, and Conditions

By participating in this savings program, participants understand and agree that the information provided, as well as non-personally identifiable information obtained from the pharmacy, will be shared with the manufacturer and with any companies working with the manufacturer. Participants also affirm that they will not submit, and have not had submitted on their behalf, a claim for reimbursement or coverage for items purchased with this card under Medicaid, Medicare, TRICARE, or any other federal or state government healthcare program, or where prohibited by state law.

  • Offer applies to out‐of‐pocket expenses (co‐pay) greater than $30. Out‐of‐pocket expenses greater than $30 will be covered up to $230 per prescription. If your total out‐of‐pocket cost exceeds $230, you will be responsible for a $30 co‐pay plus any additional amount over $230. If your co‐pay is already $30 or less, this offer does not apply.
  • Offer applies only to Qbrelis patients and associated refills.
  • This offer is not valid for prescriptions paid in part or in full by any federally or state‐funded program, including but not limited to Medicaid, Medicare, Department of Veterans Affairs, Department of Defense, or TRICARE, and where prohibited by law.
  • For questions about eVoucherRx™, please call: 800‐388‐2316 Relay Pharmacy Help Desk/Customer Support.
  • For questions about Voucher On Demand™, please call: 866‐379‐6389 Change Healthcare Help Desk/Customer Support.
  • This savings program cannot be combined with any other coupon, certificate, voucher, or similar offer.
  • Offer good only in the USA at participating retail pharmacies and cannot be redeemed at government‐subsidized clinics. Void where taxed, restricted, or prohibited by law.
  • Offer not extended to clubs, groups, or organizations.
  • Participation in this program must comply with all applicable laws and contractual or other obligations as a pharmacy provider.
  • This is not an insurance program.
  • Participating patients and pharmacists understand and agree to comply with the Terms and Conditions of this offer as set forth herein.
  • Any step‐edits or prior authorizations required by the insurance plan still apply.
  • Silvergate Pharmaceuticals, Inc. reserves the right to modify or cancel this program at any time.
  • eVoucherRx™ and Voucher On Demand™ are not extended on prescriptions for patients:
    • who are cash‐paying customers.
    • using institution-based pharmacies to fill their prescriptions, or who are recipients of federal or state government health care.
    • who are filling their prescriptions at nonparticipating pharmacies.
eVoucherRx™ is a trademark of RelayHealth.
Voucher On Demand™ is a trademark of Change Healthcare.