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Print this page and take it to your pharmacy!

After your doctor prescribes MOVANTIK:

  1. You may print a Savings Card
  2. Confirm your eligibility
  3. Bring prescription and Savings Card to your pharmacy

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*Subject to complete eligibility rules; restrictions apply. See below for eligibility information and instructions. If eligible, show your card and prescription to your pharmacist for instant savings.

ELIGIBILITY:

You may be eligible for this offer if you are insured by commercial insurance and your insurance does not cover the full cost of your prescription, or you are not insured and are responsible for the cost of your prescriptions.

Patients who are enrolled in a state or federally funded prescription insurance program are not eligible for this offer. This includes patients enrolled in Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DOD) programs or TriCare, and patients who are Medicare eligible and enrolled in an employer-sponsored group waiver health plan or government-subsidized prescription drug benefit program for retirees.

If you are enrolled in a state or federally funded prescription insurance program, you may not use this Savings Card even if you elect to be processed as an uninsured (cash-paying) patient.

This offer is not insurance and is restricted to residents of the United States and Puerto Rico and patients over 18 years of age. This offer is valid for retail prescriptions only.

TERMS OF USE:

Eligible commercially insured patients with a valid prescription for MOVANTIK® (naloxegol) Tablets who present this Savings Card at participating pharmacies will pay $0 per 30-day supply, subject to a maximum savings of $100 per 30-day supply. Cash-paying patients will receive up to $100 in savings on out-of-pocket costs that exceed $0 per 30-day supply. This offer is good for 12 uses and each 30-day supply counts as 1 use. Other restrictions may apply. Patient is responsible for applicable taxes, if any. If you have any questions regarding this offer, please call 1-984-444-7010.

Offer expires on [12/31/2020].

Non-transferable, limited to one per person, cannot be combined with any other offer. Void where prohibited by law, taxed, or restricted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer. RedHill reserves the right to rescind, revoke, or amend this offer, eligibility, and terms of use at any time without notice. This offer is not conditioned on any past, present, or future purchase, including refills. Offer must be presented along with a valid prescription for MOVANTIK® (naloxegol) Tablets at the time of purchase.

BY USING THIS CARD, YOU AND YOUR PHARMACIST UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

Program managed by ConnectiveRx on behalf of RedHill Biopharma Inc.

PATIENT INSTRUCTIONS

Present this offer to your pharmacist along with a valid prescription for MOVANTIK® (naloxegol) Tablets. Please call 1-844-327-1955 with questions and for full eligibility details.

TERMS AND CONDITIONS

Offer good for eligible patients purchasing a 30-day supply. Eligible commercially insured patients will pay $0 per 30-day supply, subject to a maximum savings of $100 per 30-day supply. Uninsured (cash-paying) patients will receive up to $100 in savings on out-of-pocket costs that exceed $0 per 30-day supply. Offer good for 12 uses; each 30-day supply counts as 1 use. Offer not valid for prescriptions purchased under Medicaid, Medicare, or similar state or federally sponsored programs. Offer not valid for patients enrolled in a state or federally funded prescription insurance program even if patient elects to be processed as an uninsured patient. Offer valid for retail prescriptions, residents of the United States and Puerto Rico, and patients over 18 years of age only. Patient is responsible for any applicable taxes. Offer expires on 12/31/20. Offer is not transferable, is not insurance, is limited to one per person, and may not be combined with any other offer. Void where prohibited by law, taxed, or restricted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer. Offer may be changed or discontinued at any time without notice. Offer not conditioned on any past, present, or future purchase. More details on movantik.com.

PHARMACIST INSTRUCTIONS FOR A PATIENT WITH AN ELIGIBLE THIRD PARTY

Submit the claim to the primary Third-Party Payer first, then submit the balance due to Therapy First Plus as a Secondary Payer COB with patient responsibility amount and a valid Other Coverage Code (eg, 8). The patient is responsible for the first $0 on a 30-day supply, and the card will cover up to $100 per 30-day supply. Reimbursement will be received from Therapy First Plus.

PHARMACIST INSTRUCTIONS FOR A CASH-PAYING PATIENT

Submit this claim to Therapy First Plus. A valid Other Coverage Code (eg, 1) is required. The card will cover up to $100 per 30-day supply. Reimbursement will be received from Therapy First Plus.

VALID OTHER COVERAGE CODE REQUIRED

For any questions regarding Therapy First Plus online processing, please call the Help Desk at 1-800-422-5604.

IMPORTANT SAFETY INFORMATION ABOUT MOVANTIK

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  • MOVANTIK may cause serious side effects, including:
    • Opioid withdrawal. You may have symptoms of opioid withdrawal during treatment with MOVANTIK, including sweating, chills, diarrhea, stomach pain, anxiety, irritability, and yawning. Patients taking methadone to treat their pain may be more likely to experience stomach pain and diarrhea. Tell your doctor if you have any of these symptoms
    • Severe Stomach Pain and/or Diarrhea. This can happen within a few days of starting MOVANTIK and can lead to hospitalization. If either of these side effects occurs, stop taking MOVANTIK and call your doctor immediately
    • Tear in your stomach or intestinal wall (perforation). Stomach pain that is severe can be a sign of a serious medical condition. If you get stomach pain that gets worse or does not go away, stop taking MOVANTIK and get emergency medical help right away
  • Do not take MOVANTIK if you:
    • Have a bowel blockage (intestinal obstruction) or have a history of bowel blockage
    • Are allergic to MOVANTIK or any of the ingredients in MOVANTIK
  • MOVANTIK can interact with other medicines and cause side effects, including opioid withdrawal symptoms (see symptoms above). Tell your doctor or pharmacist before you start or stop any medicines during treatment with MOVANTIK
  • Before you take MOVANTIK, tell your doctor about all of your medical conditions, including if you:
    • Have any stomach, bowel (intestines) problems, including inflammation in parts of the large intestine (diverticulitis), or inflammation and injury of the intestines caused by reduced blood flow (ischemic colitis)
    • Have had recent surgery on the stomach or intestines
    • Have any kidney, or liver problems
    • Are pregnant or plan to become pregnant. Taking MOVANTIK during pregnancy may cause opioid withdrawal symptoms in you or your unborn baby. Tell your healthcare provider right away if you become pregnant during treatment with MOVANTIK
    • Are breastfeeding or plan to breastfeed. It is not known if MOVANTIK passes into your breast milk. Taking MOVANTIK while you are breastfeeding may cause opioid withdrawal in your baby. You and your healthcare provider should decide if you will take MOVANTIK or breastfeed. You should not breastfeed if you take MOVANTIK
  • Tell your doctor about all of the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Other medicines may affect the way MOVANTIK works
  • If you stop taking your opioid pain medicine, stop taking MOVANTIK and tell your doctor
  • Avoid eating grapefruit or drinking grapefruit juice during treatment with MOVANTIK
  • The most common side effects of MOVANTIK include: Stomach (abdomen) pain, diarrhea, nausea, gas, vomiting, headache, and excessive sweating

APPROVED USE FOR MOVANTIK

MOVANTIK is a prescription medicine used to treat constipation that is caused by prescription pain medicines called opioids, in adults with long-lasting (chronic) pain that is not caused by active cancer.

You are encouraged to report Adverse Reactions to RedHill Biopharma Inc. at 1-833-ADRHILL (1-833-237-4455) or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.