Save on your prescription and receive NAYZILAM support

Eligible commercial patients* may pay as little as $20 per box of NAYZILAM^® (midazolam) nasal spray, CIV. Just present the NAYZILAM Patient Savings Card at your pharmacy when filling your prescription. Patients who are covered by any state or federal program are not eligible. Please see Eligibility Criteria and Terms.

The NAYZILAM Patient Savings Card will expire at the end of the calendar year.

Here’s how to start saving with the NAYZILAM Patient Savings Card:

If you do not have an LLS Financial Assistance Copay Portal Account: If this is your first time visiting the LLS Financial Assistance Copay Portal, you will need to register before you can start the online application. To create a portal account: Complete the registration form in the LLS Financial Assistance Copay Portal and submit. Save on your prescription and receive NAYZILAM support. Eligible commercial patients. may pay as little as $20 per box of NAYZILAM ® (midazolam) nasal spray, CIV. Just present the NAYZILAM Patient Savings Card at your pharmacy when filling your prescription. Copayments will be waived retroactively to March 18 for certain testing and office visits related to the testing. The test must be one approved, cleared, or authorized by the Food and Drug Administration to detect SARS-CoV-2 or diagnose COVID-19.

Register for your card

Present the card at the pharmacy when filling your prescription

HAVING TROUBLE GETTING STARTED?

If you have questions on your eligibility or how to sign up for the NAYZILAM Patient Savings Card, you can also call OPUS Health at 1-888-786-5879.

Patient Assistance Program

UCB, the maker of NAYZILAM, remains committed to helping epilepsy patients gain access to the medicines we manufacture. The NAYZILAM Patient Assistance Program may be able to help if you do not have health insurance or if you otherwise cannot afford your NAYZILAM medicine.

The NAYZILAM Patient Assistance Program may provide medication at no cost to eligible patients who are unable to pay for their NAYZILAM prescription.

To find out if you might be eligible for assistance, or to learn more about the NAYZILAM Patient Assistance Program, contact ucbCARES^®.

4 point system in textile. Get started by reviewing the program instructions and filling out the application form.

ucbCARES is the hub for information on all UCB products. Reach out to our team of nurses, pharmacists, and customer service professionals to:

• Ask questions about UCB products
• Report side effects or product quality concerns

• Get clinical trial information and support
• Find information on affording your UCB medication

CONNECT WITH US

Eligibility Criteria and Terms: This savings card is not valid for use by patients who are covered by any federally funded or state-funded healthcare program (including, but not limited to, Medicare [Part D and Medigap] and those who are Medicare-eligible and enrolled in an employer-sponsored health plan for retirees, Medicaid, any state pharmaceutical assistance program, TRICARE, VA, or DoD), or for cash-paying patients. Offer good only in the U.S., including Puerto Rico. This card is good for use only with a valid NAYZILAM prescription consistent with the approved FDA labeling at the time the prescription is filled by the pharmacist and dispensed to the patient. The maximum annual benefit amount is $1200 per calendar year. Void where prohibited by law, taxed, or restricted. This offer cannot be combined with any other promotional offer. Broadcom ush driver windows 7 32 bit dell latitude e4310. UCB, Inc. reserves the right to rescind, revoke, or amend this offer without notice at any time. No cash value. Not eligible for sale, purchase, trade, or counterfeit.

TO PATIENT: When you use this card, you are certifying that you meet the complete Eligibility Criteria and Terms and that you have not submitted, and will not submit, a claim for reimbursement under any federal, state or other governmental programs for this prescription. If you have any questions regarding the NAYZILAM Patient Savings Program or wish to discontinue your participation, please call 1-888-786-5879 (8:30 am – 5:30 pm ET, Monday – Friday and 8:30 am – 2 pm ET, Saturday).

TO PHARMACIST: Your acceptance of this card and your submission of claims for the NAYZILAM Patient Savings Program are subject to the Terms and Conditions established by OPUS Health. Submit the claim to the Primary Third-Party Payer first, then submit the balance due to OPUS Health as a Secondary Payer as a co-pay only billing using Other Coverage Code indication. You will receive the remaining balance, plus a handling fee, in your next reimbursement from OPUS Health. If you have questions, please contact the OPUS Pharmacy Support line at 1-888-786-5879.

Costs

• Most costs are for calendar year 2021 unless noted separately.
• For US Family Health Plan and TRICARE Prime Remote costs, choose 'TRICARE Prime' from the pull-down menu
• Visit the Cost Terms page for definitions to help you better understand TRICARE costs.
• If you're an unremarried former spouse, for the Continued Health Care Benefit Program (CHCBP), chose 'Retired' regardless of your sponsor's status
• Looking for dental costs? Visit the TRICARE Dental Costs section.

Copay

Copayments will be waived retroactively to March 18 for certain testing and office visits related to the testing. The test must be one approved, cleared, or authorized by the Food and Drug Administration to detect SARS-CoV-2 or diagnose COVID-19. If you paid any copayments for testing related to COVID-19 and the resulting office visits with a network or non- network provider, you may file a claim for reimbursement. For more information related to the coronavirus, visit the FAQ page.