XARELTO withMe Savings Card Terms & Conditions

Eligible commercially insured patients pay as little as $10 per fill. There is a limit to savings per fill. Savings may apply to co-pay, co-insurance, or deductible. Participate without sharing your income information. Your final out-of-pocket cost after the Savings Card is applied will depend on your insurance plan and pharmacy.

You will receive personalized refill notifications that will remind you when you are close to needing a refill or late to refilling your prescription of XARELTO^®. You can opt out from receiving notifications anytime by calling 888-XARELTO (888-927-3586).

Pharmacists: Please see below for processing instructions.

Non-Transferable: Patient must submit a valid prescription.

Patient: Present this offer along with a signed prescription for XARELTO^®. You must meet the Savings Card requirements every time you use the card. By using the Savings Card, you confirm that you have read, understand, and agree to the program requirements shown below and at XARELTOwithMe.com/SavingsCard. This offer is provided to you as a service by Johnson & Johnson Health Care Systems Inc. Terms will expire at the end of each calendar year. The XARELTO withMe Savings Card may change or end without notice, including in specific states. The XARELTO withMe Savings Card is only for people using commercial or private health insurance for XARELTO^®. This includes plans from the Health Insurance Marketplace. The XARELTO withMe Savings Card is not for people who use any state or federal government-funded healthcare program. Examples of these programs are Medicare, Medicaid, TRICARE, Department of Defense, and Veterans Administration. You may not seek payment for the value received from XARELTO withMe from any health plan, patient assistance foundation, flexible spending account, or healthcare savings account. To use the XARELTO withMe Savings Card, you must follow any health plan requirements, including telling your health plan how much co-payment support you get from XARELTO withMe.

Pharmacist: For insured patients, process a Coordination of Benefits (COB/split bill) claim using the patient’s prescription insurance for the PRIMARY claim. Submit SECONDARY claim to PDM under BIN # 610020. You will be reimbursed for the face value of the offer plus a dispensing fee, provided you and the customer have complied with the terms of this offer. Cash value: 1/20¢. No alterations of this offer will be accepted. Out-of-pocket cost assistance may not exceed patient’s out-of-pocket cost or amount set by the program’s limits, whichever is less. For questions regarding setup, claim transmission, patient eligibility, registration, or other issues, call 866-736-8081, Monday–Sunday, 8 _AM to 12 _AM ET.

Offer valid only for the product indicated. Any other use may constitute fraud. The selling, purchasing, trading, or counterfeiting of this card is prohibited by federal law, and such activities may result in imprisonment for not more than 10 years or fines not more than $250,000, or both. OFFER CANNOT BE COMBINED WITH ANY OTHER COUPON, DISCOUNT, PRESCRIPTION SAVINGS CARD, FREE TRIAL, OR OTHER OFFER. Customer is responsible for any sales tax. Tax charged on pre-offer price where required. This offer may not be redeemed for cash. Offer good only in the United States and its territories. Void where prohibited, taxed, or limited by law.

XARELTO withMe is limited to education about XARELTO^®, its administration, and/or the condition it treats. It is not intended to provide medical advice, replace a treatment plan you receive from your doctor or nurse, or serve as a reason for you to start or stay on treatment.