Eligibility Criteria/Terms and Conditions
By using the PIVYA Savings Program, you confirm you understand and agree to comply with the following
Terms and Conditions:
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Patient must be 18 years of age or older.
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Patient must have private/commercial insurance, whether covered or “Not Covered”. “Not Covered”
means patients who have private/commercial insurance, but the drug is not covered on their plan’s
formulary or has an NDC block, prior authorization, step edit, or other restriction that has not been met.
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This offer is not valid for any patient eligible for reimbursement of prescriptions, in whole or in part,
by any federal, state, or other governmental programs.
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Reimbursement limits apply and patients with high deductible or coinsurance plans may pay more
than $0. Patient is responsible for all costs and expenses after limits are reached.
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For questions call: (312) 395-7386.