Access Secuado 3 - SECUADO® (asenapine)

Commercially insured patients with coverage may pay as little as $15 per prescription for up to 12 prescriptions

This offer is valid for commercially insured patients only. It is not valid for prescriptions covered by or submitted for reimbursement in whole or in part under any state or federal healthcare programs (such as Medicaid, Medicare, DOD, VA, or TRICARE) or any state medical pharmacy assistance program.

This offer is valid only for citizens or legal residents of the 50 US states, the District of Columbia, and Puerto Rico.

Patients must have co-pay obligations for SECUADO_®. Patients without co-pay obligations for SECUADO_®, or whose private commercial insurance has prohibited coupons or co-payment assistance for SECUADO_®, are not eligible.

Patients may pay as little as $15 per prescription for up to 12 prescriptions. Co-pay assistance is limited to a maximum amount of $1,200 per month for the first 2 months of eligibility and $600 per month for the remainder of the Enrollment Period.

To enroll in the SECUADO_® Co-Pay Program, please complete this Patient Attestation

You must complete this Patient Attestation to receive the SECUADO_® Co-Pay Program card:

I am commercially insured, and I am not insured in whole or in part by any state or federal healthcare programs (such as Medicaid, Medicare, DOD, VA, or TRICARE) or any state medical pharmacy assistance program.

I am between the ages of 18 and 64.

I am enrolling in the SECUADO_® Co-Pay Program (“the Program”) and authorize Noven and any Program administrators to provide me services under the Program. I affirm that the information I have provided is complete, true, and accurate to the best of my knowledge.

I authorize my health insurer, pharmacy providers, and physician to disclose my personal information, including financial information; Protected Health Information, including information about my insurance, prescription, and health; and other state or federally protected personal information to Noven.

I understand that my information will be used by Noven for determining my eligibility to participate in the copay program.

I authorize and consent to the disclosure of my information as required or permitted by law. I understand this will be kept confidential and will not be further used or disclosed except to administer the Program, or as required by law. I understand that My Information may be re-disclosed and will be no longer protected by federal privacy regulations.

I understand that:

Noven reserves the right to change or cancel the Program, or terminate my enrollment, at any time.
Assistance and support provided by this Program is not contingent on any purchase obligations.

*Please check all boxes.

You are now leaving the SECUADO_® (asenapine) transdermal system website and moving to an external website independently operated and not managed by Noven

Find out if you’re eligible for the SECUADO_® Co-Pay Program

Please opt in first

You must complete this Patient Attestation to receive the SECUADO_® Co-Pay Program card:

IMPORTANT SAFETY INFORMATION and INDICATION for SECUADO_®

What is SECUADO_®?

IMPORTANT SAFETY INFORMATION

What is SECUADO_®?

IMPORTANT SAFETY INFORMATION

You are now leaving the SECUADO_® (asenapine) transdermal system website and moving to an external website independently operated and not managed by Noven

The site you are about to enter is intended specifically for US healthcare professionals.

Click continue if you are a US healthcare professional.

Find out if you’re eligible for the SECUADO® Co-Pay Program

Please opt in first

You must complete this Patient Attestation to receive the SECUADO® Co-Pay Program card:

What is SECUADO®?

IMPORTANT SAFETY INFORMATION

You are now leaving the SECUADO® (asenapine) transdermal system website and moving to an external website independently operated and not managed by Noven

The site you are about to enter is intended specifically for US healthcare professionals.

Click continue if you are a US healthcare professional.

Find out if you’re eligible for the SECUADO_® Co-Pay Program

You must complete this Patient Attestation to receive the SECUADO_® Co-Pay Program card:

What is SECUADO_®?

You are now leaving the SECUADO_® (asenapine) transdermal system website and moving to an external website independently operated and not managed by Noven