You prescribe.
We deliver.

Questions? We also deliver answers.

Perigon Pharmacy 360 will have a Care Delivery team available to answer questions about the DYANAVEL Delivered program on weekdays from 9 _AM-6 _PM ET.

1.844.698.2533 1.844.698.2533
Fax: 1.844.733.3779

All offer amounts are for a maximum of a 30-day supply of product.

^*RESTRICTIONS:

All DYANAVEL XR tablet savings offers are valid only in the United States and Puerto Rico. By using these offers, the patient certifies that he or she will comply with any terms of his or her health insurance contract requiring notification to his or her payer of the existence and/or value of the offers. It is illegal to (or offer to) sell, purchase, or trade these offers. These offers are not transferable and is limited to one offer per person per prescription. Void where prohibited by law. Tris Pharma reserves the right to rescind, revoke, or amend these offers without notice at any time.

Patients with government insurance includes all patients who are a member, recipient or beneficiary of a government healthcare program such as Medicaid, a Medicare drug benefit plan, TRICARE, or other federal or state health programs (such as medical assistance programs).

Copay Savings Program: This offer is for patients with commercial or private insurance only and not for patients with government insurance. Copay for high deductible plans may vary. Cash Discount Cards and other non-insurance plans are not valid as primary under this offer. If the patient is eligible for drug benefits under any such program, the patient cannot use this offer.

Cash Offer: This offer is available to patients if they have no insurance or are underinsured such that the patient’s applicable insurance does not adequately cover the cost of DYANAVEL. Only valid through the DYANAVEL Delivered by Perigon program.

Not for patients with prescription insurance through State Medicaid or Managed Medicaid plans. For patients with other government insurance, the patient must agree in writing to not submit a claim for reimbursement to any government insurance program and commit to paying the cash price though the end of the defined plan year. Patients may not count the cash price paid via the Cash Offer as an expense incurred for purposes of determining out-of-pocket costs for any government insurance plan, including true out-of-pocket costs (TrOOP), for purposes of calculating the out-of-pocket spending threshold or triggering catastrophic coverage for Medicare Part D plans.

Quick Start Offer: This offer is available to patients who are new to DYANAVEL tablet therapy, have a valid prescription, have commercial or government insurance that does not exclude participation in the program, and have an ongoing (>24 hours) coverage-decision delay after submission of a completed prior authorization or other similar reimbursement request. This offer is limited to one use per patient per lifetime and is non-transferable. By redeeming this offer, patient certifies that they have not previously filled a prescription for DYANAVEL tablet. The Quick Start Program for the specified prescription cannot be combined with any other rebate/coupon, free trial, or similar offer. No substitutions are permitted. Patient is responsible for applicable taxes, if any. Only valid through the DYANAVEL Delivered by Perigon program.

Patients cannot seek reimbursement for DYANAVEL supplied to the patient via the Quick Start Program from health insurance or any third party, including state or federally funded programs. Patients may not count the DYANAVEL supplied to the patient via the Quick Start Program as an expense incurred for purposes of determining out-of-pocket costs for any government insurance plan, including true out-of-pocket costs (TrOOP), for purposes of calculating the out-of-pocket threshold or triggering catastrophic coverage for Medicare Part D plans.

Please see Full Prescribing Information, including Boxed Warning regarding Abuse, Misuse and Addiction.