I have Medicare Part D or Medicare Advantage Insurance*

FEMRING SAVINGS PROGRAM

Welcome

The FEMRING Savings Program is sponsored by Millicent U.S. Inc. and is designed to help reduce your out-of-pocket cost for FEMRING if your Medicare Part D plan does not cover the product or you opt out of using your Medicare Part D prescription benefit in conjunction with this offer.

Please note that you have the option to use existing prescription coverage if you have it. If you elect to take advantage of this offer, you will need to opt out of using your Medicare Part D prescription benefit and agree to certain conditions.

To receive your FEMRING coupon, please complete the requested information below.

Terms, conditions, and limitations apply. Most eligible patients may pay as little as $190 for a 90-day supply with 1 ring. Please see below for the program's full Eligibility Criteria, Terms, and Conditions.

By enrolling in the FEMRING Savings Program you certify the following:

(1) Your Medicare plan does not cover your FEMRING prescription

(2) You will not seek any prescription coverage or reimbursement from your Medicare plan for the cost of your FEMRING prescriptions received through this offer or report any amounts paid in connection with this offer toward your True Out-Of-Pocket (TrOOP) costs under your plan

(3) You will purchase all FEMRING prescriptions covered under this offer during the calendar year by using the FEMRING Savings Program and will not use your Medicare benefits, even if your benefits change

Please enter the following information:

*Required Fields:

Patient First Name*

Patient Last Name*

Patient Date of Birth*

Patient ZIP Code*

Patient Mobile Phone Number*

Patient Email Address*

I authorize Millicent U.S. Inc., and companies working with or for it, to communicate with me by email or text message, about products, including marketing materials, health conditions, copay and financial assistance. I agree to be contacted at the email and/or phone number I provided. I consent to allow Millicent U.S. Inc. to store my information for the use of administering the program. Consent is not a condition of purchase of goods or services. For Privacy Policy go to https://millicentpharma.com/privacy-policy/. Millicent U.S. Inc. and companies providing services to Millicent U.S. Inc. will not sell or rent your personally identifiable information, as described in the Privacy Policy. *

Yes

Please confirm that by clicking submit to activate this coupon, you have read, understand and will comply with the terms and conditions of the program and that you currently meet all eligibility criteria.*

Yes

ELIGIBILITY CRITERIA/TERMS AND CONDITIONS:

The FEMRING Savings Program is valid for a cost reduction of a qualifying prescription of FEMRING for eligible patients.
The FEMRING Savings Program can only be used by eligible patients for FEMRING.
Limitations apply.
You must have prescription drug insurance through a Medicare Part D or a Medicare Advantage prescription drug plan.
You must agree to not seek reimbursement from your Medicare or Medicare Advantage prescription plan for your out-of-pocket costs for FEMRING purchased through this program.
The FEMRING Savings Program is not valid for any patients with commercial/private insurance, uninsured patients, or patients with prescription coverage under any other federal or state health program such as Medicaid or TRICARE.
No other purchase necessary.
The FEMRING Savings Program coupon is not transferable. No substitutions are permitted. Cannot be combined with any other coupon, free trial, discount, prescription savings card, or other offer not already associated with this offer.
The FEMRING Savings Program coupon is not insurance.
The FEMRING Savings Program coupon can be used at mail-order pharmacies.
The FEMRING Savings Program coupon is the property of Millicent U.S. Inc. and must be turned in on request.
It is illegal to sell, purchase, trade, or counterfeit, or offer to sell, purchase, trade, or counterfeit this coupon. Void if reproduced. Void where prohibited by law, taxed, or restricted.
Patients participating in Medicare Part D or a Medicare Advantage prescription drug plan who are eligible to use the FEMRING Savings Program coupon must agree to the following conditions: Patient must agree to not seek reimbursement from their Medicare or Medicare Advantage prescription plan for their out-of-pocket costs for FEMRING purchased with the coupon.
Patient must also agree not to count the cost of FEMRING toward their deductible or true out-of-pocket cost.
The patient must purchase all prescriptions for FEMRING with the coupon and the patient must not use the Medicare Part D benefit for FEMRING.
This coupon can be used only by eligible United States residents (including Puerto Rico, Guam, and the U.S. Virgin Islands) at participating eligible retail pharmacies in the United States. Product must originate from the United States.
Millicent U.S. Inc. reserves the right to rescind, revoke, or amend this offer at any time without notice.
Data related to your redemption of the FEMRING Savings Program coupon may be collected, analyzed, and shared with Millicent U.S. Inc. for market research and other purposes related to assessing patient savings programs. Patient understands he/she is consenting to allow Millicent U.S. Inc. to store all collected personal and medical information for the administration of this program.
For questions call: 1-312-265-4989.

The healthcare information contained herein is not intended to replace discussion with your healthcare provider. All decisions regarding patient care must be made with a healthcare provider, considering the unique characteristics of the patient. The product information provided in this site is intended only for residents of the United States. The products discussed herein may have different product labeling in different countries.