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BIJUVA Co-pay Savings Terms and Conditions

PROGRAM TERMS, CONDITIONS, AND ELIGIBILITY CRITERIA

  1. This offer is good for use only with a valid prescription for BIJUVA (estradiol and progesterone) capsules at the time the prescription is filled by the pharmacist and dispensed to the patient.
  2. During the active date of the Program, eligible patients may pay $35 or less on each of up to twelve (12) 30-day prescriptions; $105 or less on each of up to four (4) 90-day prescriptions.
  3. Maximum savings limit applies; patient out-of-pocket expense may vary.
  4. This offer is not valid for use by patients enrolled in Medicare, Medicaid, or other federal or state programs (including any state pharmaceutical assistance programs), or private indemnity or HMO Insurance plans that reimburse you for the entire cost of your prescription drugs.
  5. Void outside the United States and its territories or where prohibited by law, taxed, or restricted.
  6. This card is not health insurance, redeemable for cash, or transferable, and is not valid with any other offer.
  7. TherapeuticsMD (the Company) reserves the right to amend or end this program at any time without notice. Data related to the patient's redemption with this Co-pay Card may be collected, analyzed, and shared with the Company for market research and other purposes related to assessing coupon and rebate programs. Any data will be aggregated and de-identified.
  8. By redeeming this card, you acknowledge that you are an eligible patient and that you understand and agree to comply with the terms and conditions of this offer.

For questions about this program please call 1-855-562-0998.


Authorization to Contact

I understand and consent to TherapeuticsMD contacting me using the information provided in this form to enroll me in, operate, and administer TherapeuticsMD's patient support services and/or programs as described, including promotional communications by telephone or SMS/text. I understand that the operation and administration of certain of these services and/or programs may require TherapeuticsMD to contact me by telephone or SMS/text, or other communication vehicles and standard charges may apply.


Pharmacist Instructions for a patient with an eligible third-party payer: When you redeem this card, you certify that you have not submitted and will not submit a claim for reimbursement under any federal, state, or other government programs for this prescription.

  • Submit the claim to the primary third-party payer first and then submit the balance due to Change Healthcare as a Secondary Payer COB [coordination of benefits with patient responsibility amount and a valid Other Coverage Code, (e.g. 3 or 8). The patient’s out-of-pocket expense will be reduced up to the maximum savings limit for the program. Reimbursement will be received from Change Healthcare.
  • Valid Other Coverage Code required. For any questions regarding Change Healthcare online processing, please call the Help Desk at 1-855-421-0701. Program managed by COMP on behalf of Therapeutics MD.

IMPORTANT RISK INFORMATION

Most important information you should know about BIJUVA (estradiol and progesterone) capsules:

  • Do not use estrogens with or without progestogens to prevent heart disease, heart attacks, strokes, or dementia (decline of brain function).
  • Taking estrogens with progestogens may increase your chances of getting heart attacks, strokes, breast cancer, or blood clots.
  • Taking estrogens with progestogens may increase your chance of getting dementia, based on a study of women 65 years of age or older.
  • Taking estrogen-alone may increase your chance of getting cancer of the uterus.
  • Taking estrogen-alone may increase your chances of getting strokes or blood clots.
  • Taking estrogen-alone may increase your chance of getting dementia, based on a study of women 65 years of age or older.
  • You and your healthcare provider should talk regularly about whether you still need treatment with BIJUVA.

DO NOT USE BIJUVA IF YOU:

  • Have had your uterus (womb) removed (hysterectomy). BIJUVA contains progesterone to decrease the chance of getting cancer of the uterus. If you do not have a uterus, you do not need progesterone and you should not take BIJUVA.
  • Have any unusual vaginal bleeding. Vaginal bleeding after menopause may be a warning sign of cancer of the uterus (womb). Your healthcare provider should check any unusual vaginal bleeding to find out the cause.
  • Currently have or have had certain cancers. Estrogens may increase the chances of getting certain types of cancers, including cancer of the breast or uterus. If you have or have had cancer, talk with your healthcare provider about whether you should take BIJUVA.
  • Currently have or have had blood clots.
  • Had a stroke or heart attack.
  • Currently have or have had liver problems.
  • Have been diagnosed with a bleeding disorder.
  • Are allergic to BIJUVA or any of its ingredients.

WARNINGS

Ask a doctor before use if you:

  • Have high levels of fat in your blood (triglycerides).
  • Have any unusual vaginal bleeding.
  • Have certain medical conditions that may become worse while you are taking BIJUVA, such as: asthma (wheezing); diabetes; epilepsy (seizures); migraine; a genetic problem called porphyria; lupus; hypertension (high blood pressure); have high calcium in your blood; endometriosis; angioedema (swelling of face or tongue); problems with your heart, liver, thyroid or kidneys.
  • Are going to have surgery or will be on bed rest.
  • Are pregnant or think you may be pregnant. BIJUVA is not for pregnant women.
  • Are breastfeeding.

Tell your doctor or pharmacist about all the medicines you take,

including prescription and over-the-counter medicines, vitamins, and herbal supplements.

WHEN USING BIJUVA, YOU MAY HAVE

  • Breast tenderness
  • Headache
  • Vaginal bleeding
  • Vaginal discharge
  • Pelvic pain

Call your doctor right away if you get any of the following warning signs:

  • New breast lumps
  • Unusual vaginal bleeding
  • Changes in vision or speech
  • Sudden new severe headaches
  • Severe pains in your chest or legs with or without shortness of breath, weakness and fatigue
  • Vomiting

USE

BIJUVA is a prescription medicine that contains two hormones, estrogen and progesterone. BIJUVA is used after menopause to reduce moderate to severe hot flashes in women with a uterus.

The risk information provided here is not complete. To learn more, review the BIJUVA Patient Information and talk about BIJUVA with your healthcare provider or pharmacist. The FDA-approved product labeling, including Patient Information, can be found at www.BIJUVA.com.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch or call 1-800-FDA-1088. You may also report side effects to TherapeuticsMD® at 1-888-228-0150.

IMPORTANT RISK INFORMATION

Most important information you should know about BIJUVA (estradiol and progesterone) capsules:

  • Do not use estrogens with or without progestogens to prevent heart disease, heart attacks, strokes, or dementia (decline of brain function).
  • Taking estrogens with progestogens may increase your chances of getting heart attacks, strokes, breast cancer, or blood clots.
  • Taking estrogens with progestogens may increase your chance of getting dementia, based on a study of women 65 years of age or older.
  • Taking estrogen-alone may increase your chance of getting cancer of the uterus.
  • Taking estrogen-alone may increase your chances of getting strokes or blood clots.
  • Taking estrogen-alone may increase your chance of getting dementia, based on a study of women 65 years of age or older.
  • You and your healthcare provider should talk regularly about whether you still need treatment with BIJUVA.

DO NOT USE BIJUVA IF YOU:

  • Have had your uterus (womb) removed (hysterectomy). BIJUVA contains progesterone to decrease the chance of getting cancer of the uterus. If you do not have a uterus, you do not need progesterone and you should not take BIJUVA.
  • Have any unusual vaginal bleeding. Vaginal bleeding after menopause may be a warning sign of cancer of the uterus (womb). Your healthcare provider should check any unusual vaginal bleeding to find out the cause.
  • Currently have or have had certain cancers. Estrogens may increase the chances of getting certain types of cancers, including cancer of the breast or uterus. If you have or have had cancer, talk with your healthcare provider about whether you should take BIJUVA.
  • Currently have or have had blood clots.
  • Had a stroke or heart attack.
  • Currently have or have had liver problems.
  • Have been diagnosed with a bleeding disorder.
  • Are allergic to BIJUVA or any of its ingredients.

WARNINGS

Ask a doctor before use if you:

  • Have high levels of fat in your blood (triglycerides).
  • Have any unusual vaginal bleeding.
  • Have certain medical conditions that may become worse while you are taking BIJUVA, such as: asthma (wheezing); diabetes; epilepsy (seizures); migraine; a genetic problem called porphyria; lupus; hypertension (high blood pressure); have high calcium in your blood; endometriosis; angioedema (swelling of face or tongue); problems with your heart, liver, thyroid or kidneys.
  • Are going to have surgery or will be on bed rest.
  • Are pregnant or think you may be pregnant. BIJUVA is not for pregnant women.
  • Are breastfeeding.

Tell your doctor or pharmacist about all the medicines you take,

including prescription and over-the-counter medicines, vitamins, and herbal supplements.

WHEN USING BIJUVA, YOU MAY HAVE

  • Breast tenderness
  • Headache
  • Vaginal bleeding
  • Vaginal discharge
  • Pelvic pain

Call your doctor right away if you get any of the following warning signs:

  • New breast lumps
  • Unusual vaginal bleeding
  • Changes in vision or speech
  • Sudden new severe headaches
  • Severe pains in your chest or legs with or without shortness of breath, weakness and fatigue
  • Vomiting

USE

BIJUVA is a prescription medicine that contains two hormones, estrogen and progesterone. BIJUVA is used after menopause to reduce moderate to severe hot flashes in women with a uterus.

The risk information provided here is not complete. To learn more, review the BIJUVA Patient Information and talk about BIJUVA with your healthcare provider or pharmacist. The FDA-approved product labeling, including Patient Information, can be found at www.BIJUVA.com.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch or call 1-800-FDA-1088. You may also report side effects to TherapeuticsMD® at 1-888-228-0150.