Some health plans have programs or benefit designs known as “accumulators” or “maximizers.” These programs divert patient assistance funds away from patients.

• Accumulators don’t allow patient assistance to count toward the patient’s deductible and out-of-pocket maximum until the maximum value of the patient assistance is reached.
• Maximizers also don’t allow patient assistance to count toward the patient’s deductible and out-of-pocket maximum. Maximizers apply the full value of the patient assistance over the year. This could be either the same amount each month or a larger amount early in the year that tapers off, without allowing any of those funds to count toward the patient’s annual deductible or out-of-pocket maximum.
• The XARELTO withMe Savings Card is designed solely for the benefit of the patient. Thus, Johnson & Johnson reserves the right to reduce the XARELTO withMe Savings Card maximum benefit for patients in an accumulator or maximizer program or benefit design, except where prohibited by law.

In addition, some health plans have “non-essential health benefit maximizers” that conflict with the requirements of the XARELTO withMe Savings Card.

• These programs or benefit designs, like the services offered by SaveOnSP, classify certain specialty medicines such as XARELTO^® as “non-essential.” This takes away protections for patients provided by the Affordable Care Act (ACA) related to maximum out-of-pocket limits.
• The XARELTO withMe Savings Card is designed solely for the benefit of the patient. If your insurance company or health plan partners with SaveOnSP, then except where prohibited by law, you will not be eligible for, and you agree not to use, the XARELTO withMe Savings Card.
• Please let XARELTO withMe know if your insurance company or health plan has one of these programs or benefit designs, including SaveOnSP, by calling 888-XARELTO (888-927-3586) to discuss your options. Since you may not know you are subject to one of these programs or benefit designs when you enroll in XARELTO withMe, J&J will monitor your utilization.
• J&J reserves the right to discontinue cost support if you no longer meet eligibility requirements.
• If your health plan removes XARELTO^® from its partnership with SaveOnSP or other non-essential health benefit maximizer, you may be eligible to be reinstated in the XARELTO withMe Savings Card.

By utilizing this Savings Card, you accept and agree to abide by these Savings Card requirements. Any individual or entity who enrolls or assists in the enrollment of a patient in the Savings Card represents that the patient meets the eligibility criteria and other requirements described.

Other Requirements

The XARELTO withMe Savings Card is only for people using commercial or private health insurance who must pay an out-of-pocket cost for their prescribed 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.

• By enrolling in the XARELTO withMe Savings Card, you agree that this Savings Card is intended solely for the benefit of you, the patient. You may not seek payment for the value received from the XARELTO withMe Savings Card from any health plan, patient assistance foundation, flexible spending account, or healthcare savings account.
• You must meet the XARELTO withMe Savings Card requirements every time you use the card.
• 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.
• XARELTO withMe Savings Card participants are subject to a limit per fill. Savings Card benefits are set at the discretion of J&J and may change without notice.
• Patients who are subject to programs, health plans, or benefits that claim to reduce their patients’ out-of-pocket co-pay, co-insurance, or deductible obligations for certain prescription drugs based upon the availability of, or patient’s enrollment in, manufacturer-sponsored co-pay assistance for such drugs will be subject to a reduced annual maximum benefit per calendar year (not applicable to patients in Maine).
• Patients who are subject to programs, health plans, or benefits that claim to eliminate their out-of-pocket costs are not eligible for the XARELTO withMe Savings Card, because this Savings Card is only for people who must pay an out-of-pocket cost for XARELTO^®.
• Notwithstanding any other term of this Savings Card, patients who are members of health plans that partner with SaveOnSP, or who are subject to services administered by SaveOnSP, are not eligible for the XARELTO withMe Savings Card. If your health plan removes XARELTO^® from its partnership with SaveOnSP, you may be eligible for the XARELTO withMe Savings Card.
• 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 the XARELTO withMe Savings Card, if required. By using the Savings Card, you confirm that you have read, understood, and agree to the requirements on this page, and you are giving permission for information related to your Savings Card transactions to be shared with your healthcare provider(s). These transactions include rebates and any funds placed on the card or balance remaining on the card.
• Before you enroll in the XARELTO withMe Savings Card, you will be asked to provide personal information that may include your name, address, phone number, email address, and/or other information, including information related to your prescription medicine insurance and treatment. This information is needed for Johnson & Johnson Health Care Systems Inc. and our service providers to enroll you for the XARELTO withMe Savings Card. The use of your information will be governed by our PRIVACY POLICY.
• If your pharmacy can’t process your Savings Card, you may still be able to receive a rebate by submitting a rebate request. Rebate requests must be submitted within 365 days of the date of service.
• This offer may not be used with any other coupon, discount, prescription savings card, free trial, or other offer. Offer good only in the United States and its territories, including Puerto Rico. Void where prohibited, taxed, or limited by law.

You may end your participation in XARELTO withMe at any time by calling 888-XARELTO (888-927-3586).