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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

If eligible, you may SAVE* on your prescription.
Present this Savings Card printout to your pharmacist
Savings Card

BIN: 004682

PCN: CN

GRP: EL57017079

ID:

*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 844-4-MOVSAVE.

Offer expires on 12/31/2021.

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 Biopharma 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 Ltd.

PATIENT INSTRUCTIONS
Present this offer to your pharmacist along with a valid prescription for MOVANTIK® (naloxegol) Tablets. Please call 844-4-MOVSAVE 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 12/31/21. 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.

PATIENT 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.

MOVANTIK is a registered trademark of the AstraZeneca group of companies.
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