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The EUFLEXXA Commitment
Offer Terms and Conditions:

• This offer is not valid for any other Ferring Pharmaceuticals Inc product. Fax-in only. No mail, phone, or emailed requests will be honored
• Ferring Pharmaceuticals is not responsible for lost, late, damaged, misdirected, incomplete or illegible submissions
• The value of this refund may not exceed the amount of patient’s responsibility (copay) for the prescription. Maximum amount is $100
• Offer limited to patients who received EUFLEXXA for the first time
• Offer valid only for patients undergoing their first EUFLEXXA treatment regimen
• Offer is valid for US residents who receive three (3) injections of EUFLEXXA within 21 days as indicated (i.e. one injection a week for 3 weeks)
• Refund claims must be received between 10 and 14 weeks after the last injection. All claims must be received by January 31, 2021
• Limit one refund per eligible patient
• Ferring Pharmaceuticals reserves the right to cancel, modify, or rescind the program at any time
• The patient responsibility (copay) for the injection administration and/or EUFLEXXA must be isolated on the claim. Office visits or other ancillary costs included in patient’s responsibility are excluded from refund amount
• This offer is void where prohibited or restricted by law. Offer not valid for prescriptions and/or services reimbursed in whole or in part by any federal or state healthcare program, including without limitation Medicare, Medicaid, Department of Veterans Affairs healthcare program, TRICARE, and any federal or state employee benefit program
• Please retain copies of the materials you submit. All submissions become the property of a Ferring Pharmaceuticals contracted third-party vendor
• Patient must fully complete and follow instructions as stated on the claim form
• Tampering with, altering, or falsifying payment information constitutes fraud
• Please allow 4-6 weeks for delivery of refund check. Refund check will be issued in US dollars

Terms and Conditions:

Eligibility criteria for Patient Direct Program

• Must be 18 years of age or older and have a valid EUFLEXXA prescription
• Must be a resident of the United States or US territories, except residents of Massachusetts are not eligible for this program
• Must be uninsured or have commercial insurance only. Those participating in any federal or state healthcare program, including without limitation Medicare, Medicaid, the Department of Veterans Affairs healthcare program, TRICARE, and any federal or state employee benefit program are not eligible for the program
• Additional terms and conditions apply