After your doctor prescribes MOVANTIK:

PATIENT INSTRUCTIONS: Present this offer to your pharmacist along with a valid prescription for MOVANTIK^® (naloxegol) Tablets. Please call 312-896-0135 with questions and for full eligibility details.

TERMS AND CONDITIONS: Offer good for patients who meet eligibility criteria purchasing a 30-, 60-, or 90-day supply. Eligible commercially insured patients will pay as little as $0 for their monthly prescription, subject to a maximum benefit limit. Eligible uninsured (cash-paying) patients will receive savings on eligible out-of-pocket costs subject to a maximum benefit limit.

This program provides eligible patients with assistance to reduce out-of-pocket costs. By using this offer, patient and pharmacist understand and agree to comply with these terms and conditions. Only eligible U.S. residents may use this offer at participating pharmacies and may not redeem this offer at government-subsidized clinics. Offer user must be at least 18 years of age to use for themselves or on behalf of a minor. Patient age or insurance restrictions may apply.

Restrictions: No substitutions are permitted. Offer eligible only with valid prescription, has no cash value, and cannot be combined with any free trial, discount, prescription savings card, or other offer. This offer is not insurance. Valid only for patients with commercial insurance. This offer is NOT valid for prescriptions eligible to be reimbursed in whole or in part by Medicaid, Medicare (including Medicare Advantage and Part D plans), Veterans Affairs (VA), Department of Defense (DOD) programs or TriCare, or any other federally or state funded healthcare benefit program, or by commercial plans or health or pharmacy benefit programs that reimburse for the entire cost of the prescription drug or prohibit offer’s use. Medicare Part D enrollees who are in the prescription drug coverage gap are not eligible for offer. This offer is not transferable and is limited to one offer per person. Void were prohibited by law, taxed, or restricted. It is illegal to sell, purchase, trade, or counterfeit, or offer to sell, purchase, trade, or counterfeit the offer.

Valinor Pharma, LLC, reserves the right to rescind, revoke, or amend the offer at any time without notice.

Pharmacist instruction for a patient with an eligible Third-Party Payer: Submit the claim to the primary Third-Party Payer first, then submit the balance due as a Secondary Payer using Secondary Payer COB [coordination of benefits] with patient responsibility amount and a valid Other Coverage Code (eg, 8 or 3).

Pharmacist instruction for a cash-paying patient: Submit this claim as a Primary Payer using a valid Other Coverage Code (eg, 1).

For any questions regarding online processing, call the Pharmacy Help Desk at 312-896-0147.