US Patient Savings Information

Hill Dermaceuticals, the manufacturer, has made arrangements for a patient savings program with Royal products, to assist patients with private prescription insurance to reduce their co-pay amount. This offer applies to out‑of‑pocket expenses (co-pay) greater than $25. Out‑of‑pocket expenses greater than $25 will be covered up to $75 per use.1 If your total prescription cost exceeds $100, you will be responsible for a $25 co-pay plus any additional amount over $100. If your co-pay is already $25 or less, this offer does not apply.2

This savings is applied electronically and automatically at the point of sale (a participating pharmacy). If you are a private insurance patient, simply take your prescription for Derma-Smoothe/FS® (SCALP OIL), Derma-Smoothe/FS® (BODY OIL) and/or DermOtic® Oil Ear Drops to one of the 55,000 pharmacies participating nationwide3 (or your doctor’s office may send it electronically) and the savings is automatically applied. No physical card or coupon required. When you use this patient assistance program, you are certifying that you understand the program rules, regulations, and Terms and Conditions. You are not eligible if prescriptions are paid in full or part by any state or other federally funded programs, including, but not limited to Medicare or Medicaid, Medigap, VA, DOD, or TriCare, or where prohibited by law; and you will otherwise comply with the terms and conditions of this program.4,5

TO PRESCRIBER: Write the prescription for the brand (Derma-Smoothe/FS® (SCALP OIL), Derma-Smoothe/FS® (BODY OIL) and/or DermOtic® Oil Ear Drops) and include the appropriate wording required by your State Statute to avoid generic substitution. (Generics are NOT covered under this program).

TO PATIENT: Take your prescription to a participating pharmacy. The discount will appear on your pharmacist’s screen when they enter the product name and your private prescription insurance information.

1 A maximum of $75 dollars refund applies to each use of the card regardless of the amount of bottles purchased. For examples, a patient purchasing three bottles at once would still only receive a maximum of $75. However, if you purchase one bottle three separate times as refills, the evoucher would apply each time.

2 Maximum benefit up to $75.00. Program includes refills. No paper coupons needed. Savings automatically applied at participating pharmacy.

3 Not all pharmacies participate. Participation status subject to change. For a current list of participating pharmacies, please visit: http://evoucherrx.relayhealth.com/storelookup.

4 Hill Dermaceuticals, Royal Pharmaceuticals and eVoucher reserve the right to change or modify or end the terms of this program without prior notice. Terms and conditions listed here are also subject to any further terms and conditions imposed by eVoucher or law.

5 By participating in this savings program, participants understand and agree that the information provided, as well as information obtained about them from the pharmacy, will be shared with the manufacturer and by any companies working with the manufacturer. Participants also affirm that they will not submit, and have not had submitted on their behalf, a claim for reimbursement or coverage for items purchased with this card under Medicaid, Medicare, TRICARE, or any other federal or state government healthcare program, or where prohibited by state law.

TO PHARMACIST: When using this e-Voucher, you are certifying that you have not submitted and will not submit a claim for reimbursement under any federal, state or other governmental programs for this prescription.

TERMS AND CONDITIONS

  • This offer applies to out-of-pocket expenses (copay) greater than $25 only. Out-of-pocket expenses greater than $25 will be covered up to $75 per prescription. If your total prescription cost exceeds $100, you will be responsible for a $25 copay plus any additional amount over $100. If your copay is already $25 or less, this offer does not apply.
  • This offer is NOT valid for prescriptions paid in part or in full by any federally or state-funded program, including but not limited to Medicaid, Medicare, Department of Veterans Affairs, Department of Defense, or TRICARE, and where prohibited by law.
  • This savings program cannot be combined with any other coupon, certificate, voucher, or similar offer.
  • Offer good only in the USA at participating retail pharmacies and cannot be redeemed at government or government -subsidized clinics.
  • Void where taxed, restricted, or prohibited by law.
  • Offer not extended to clubs, groups, or organizations.
  • Participation in this program must comply with all applicable laws and contractual or other obligations as a pharmacy provider.
  • This is not an insurance program.
  • Participating patients and pharmacists understand and agree to comply with the Terms and Conditions of this offer as set forth herein.
  • Any step therapy algorithms and/or prior authorizations required by the insurance plan still apply.
  • Royal Pharmaceuticals, Inc., Hill Dermaceuticals, Inc. or e-Voucher reserves the right to modify or cancel this program at any time.
  • This offer is limited to one eVoucher per patient per use (regardless of the number of bottles purchased).
  • eVoucherRx™ is not extended on prescriptions for patients:
    • Who are cash-paying customers
    • Using mail-order or institution-based pharmacies to fill their prescriptions, or who are federal or state government employees
    • Who are filling their prescriptions at nonparticipating pharmacies

For full prescribing information see www.Royal-Pharmaceuticals.com and www.Hillderm.com.

For product information: Hill Dermaceuticals at 1-800-344 5707.

 

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Royal Pharmaceuticals

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