Copay Assistance Program

    The Direct Access Program provides eligible* patients with NeutraSal® at little to no cost

    What the program offers*

    • Little to no copay costs for patients with commercial insurance*
    • Cash purchase option is available at a discount

    How to start using the program

    • Complete the Prescription Referral Form
    • Submit a copy of the prescription benefits card
    • Separate prescription not required
    • Contact the pharmacy at 1-877-373-2734 with questions
    • No registration needed by physician or patient

    How the patient receives NeutraSal®

    • Patients will be qualified by a licensed pharmacy for prescription drug benefits
    • All medication will be shipped directly to the patient
    • If your patient does not have pharmacy benefits, they may qualify for a free box of Neutrasal®.*

    INDICATIONS

    NeutraSal® is indicated for dryness of the mouth (hyposalivation, xerostomia) and dryness of the oral mucosa due to drugs that suppress salivary secretion.

    IMPORTANT SAFETY INFORMATION

    • Not intended to prevent xerostomia or oral mucositis.
    • Patients should avoid eating or drinking for at least 15 minutes after use
    • Solution should not be swallowed but be spit out.
    • Not intended for systemic use to treat any diseases of the throat or upper gastrointestinal tract
    • Not intended for use as an antacid
    • No adverse events anticipated if swallowed accidentally
    • Contains sodium; consult with patients on a low sodium diet
    • No known interactions with medicinal or other products

    Please click here for Instructions for Use.

    *Terms and Conditions: This offer is only valid for patients with commercial insurance where NeutraSal® (Supersaturated Calcium Phosphate Rinse) is a covered medication. This offer is not valid for any person eligible for reimbursement of prescriptions, in whole or in part, by any federal, state, or other governmental programs, including, but not limited to, Medicare (including Medicare Advantage and Part A, B, and D plans), Medicaid, TRICARE, Veterans Administration or Department of Defense health coverage, CHAMPUS, the Puerto Rico Government Health Insurance Plan, or any other federal or state health care programs. You agree not to seek reimbursement for all or any part of the benefit received through this offer and are responsible for making any required reports of your use of this offer to any insurer or other third party who pays any part of the prescription filled. This offer is good only in the United States of America (including the District of Columbia, Puerto Rico and the U.S. Virgin Islands) This offer is not valid where otherwise prohibited, taxed, or otherwise restricted. This offer is not valid for any person that is 65 years of age or older without commercial insurance. You must be 18 years of age or older to redeem this offer for yourself or a minor. This offer cannot be redeemed at government-subsidized clinics. This offer is valid for one (1) initial prescription fill of NeutraSal® and up to ten (10) prescription refills. The maximum benefit available is $1,500. You are responsible for all costs and expenses after the maximum benefit is reached. If you receive coverage through a health savings account (HSA) or similar arrangement, it is your responsibility to know how claims are processed and understand that amounts paid by the third party for your NeutraSal® prescription may be deducted from your benefits limit automatically. This offer is not valid with other offers. The coupon has no cash value. No cash back. This offer is not health insurance. This offer expires on December 31, 2018. Valeant Pharmaceuticals and OraPharma reserve the right to rescind, revoke, terminate, or amend this offer at any time, without notice.

     

    Copyright © 2018, Valeant Pharmaceuticals North America LLC    NSL.0041.USA.18

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    INDICATIONS

    NeutraSal® is indicated for dryness of the mouth (hyposalivation, xerostomia) and dryness of the oral mucosa due to drugs that suppress salivary secretion.

    IMPORTANT SAFETY INFORMATION
    • Not intended to prevent xerostomia or oral mucositis.
    • Patients should avoid eating or drinking for at least 15 minutes after use
    • Solution should not be swallowed but be spit out.
    • Not intended for systemic use to treat any diseases of the throat or upper gastrointestinal tract
    • Not intended for use as an antacid
    • No adverse events anticipated if swallowed accidentally
    • Contains sodium; consult with patients on a low sodium diet
    • No known interactions with medicinal or other products

    Please click here for Instructions for Use.