Vevye Connects

I Have Commercial Insurance

*By downloading this card you are verifying that you have commercial insurance and do NOT have Medicare Part D or Medicare Advantage Plan.

You also verify that your prescriptions are NOT paid for in part or full by any federally funded program, including Medicaid, Tricare, DOD, and VA.

Yes

Please call 316-219-4495 to learn about additional savings options that may be available to you.

*By clicking "DOWNLOAD SAVINGS CARD" you confirm that you read and understand the Terms and Conditions, Privacy Policy, and Legal Notice of the program set forth below and that you currently meet all eligibility criteria and will comply with the Terms and Conditions of the savings program.

By checking this, I consent to receive a text message to the phone number provided that will contain my VEVYE Savings Program, savings alerts, and refill reminders. Message and data rates may apply. Message frequency varies. I can opt out of texting at any time by replying STOP, or text HELP for help.

All fields marked with an asterisk are required. See Terms and Conditions, and our Privacy Policy for data collection terms.

*Terms and Conditions:

For patients whose prescriptions are covered by commercial insurance, use of this card may reduce your copayment so that you may pay as little as $0.
This card is not valid for prescriptions paid for in part or full by Medicare, Medicaid, Tricare, DOD, VA, or any state or federally funded program.
This program is subject to overall maximum support amounts.
This offer shall be applied only toward the cost of an eligible prescription product and not toward ancillary services or treatment costs.
This offer is only good in the United States of America (including the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands).
You must present this coupon along with your prescription to participate in this program.
This offer is not health insurance.
The selling, trading, or counterfeiting of this coupon is prohibited by law. Void if reproduced.
This offer is not transferable.
When you use this offer, you are certifying that you understand and agree to comply with the program rules, regulations, eligibility requirements, and Terms and Conditions.
Harrow reserves the right to rescind, revoke, or amend this offer at any time.

For questions, call: 1-316-219-4495.

VEVYE^® Savings Program

Your VEVYE Savings Card is Ready to Print!

Please note that your VEVYE Savings Card must be provided to the pharmacist when you fill your prescription at any pharmacy. If you do not have access to a printer, please write down the following information found on your card: BIN#, GRP#, PCN#, ID#.

Present this card to your pharmacist
when you fill your prescription

*Terms and Conditions:

By using the Vevye Savings Program, you confirm that you understand and agree to comply with the following Terms and Conditions of this offer:

For patients whose prescriptions are covered by commercial insurance, use of this card may reduce your copayment so that you may pay as little as $0.
This card is not valid for prescriptions paid for in part or full by Medicare, Medicaid, Tricare, DOD, VA, or any state or federally funded program.
This program is subject to overall maximum support amounts.
This offer shall be applied only toward the cost of an eligible prescription product and not toward ancillary services or treatment costs.
This offer is only good in the United States of America (including the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands).
You must present this coupon along with your prescription to participate in this program.
This offer is not health insurance.
The selling, trading, or counterfeiting of this coupon is prohibited by law. Void if reproduced.
This offer is not transferable.
When you use this offer, you are certifying that you understand and agree to comply with the program rules, regulations, eligibility requirements, and Terms and Conditions.
Harrow reserves the right to rescind, revoke, or amend this offer at any time.

Pharmacist Instructions For Commercially Insured Patients:

Submit the claim to the primary commercial insurance company.
Submit the balance due as a Secondary Submission COB with the patient responsibility amount and a valid Other Coverage Code (OCC).
For eligible commercial patients when the product is covered, submit BIN and OCC 08.

Program Terms and Conditions

When you process this card, you certify that you have read, understood, and are in compliance with the terms and conditions pertaining to this program. You are further certifying that you have not submitted and will not submit a claim for reimbursement under Medicare or similar federal or state programs including any state medical pharmaceutical assistance program for this prescription.
Harrow reserves the right to rescind, revoke, or amend this offer at any time.

For questions, call: 1-316-219-4495.