AstraZeneca is committed to providing resources for our patients, their loved ones and the healthcare professionals caring for them during these uncertain times. Click here for our COVID-19 resource page.
ELIGIBILITY: You may be eligible for this offer if you are insured by commercial insurance and your insurance does not cover the full cost of your prescription, or you are not insured and are responsible for the cost of your prescriptions. Patients who are enrolled in a state or federally funded prescription insurance program are not eligible for this offer. This includes patients enrolled in Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DOD) programs or TriCare, and patients who are Medicare eligible and enrolled in an employer-sponsored group waiver health plan or government-subsidized prescription drug benefit program for retirees. If you are enrolled in a state or federally funded prescription insurance program, you may not use this savings card even if you elect to be processed as an uninsured (cash-paying) patient. This offer is not insurance, is restricted to residents of the United States and Puerto Rico, and to patients over 18 years of age. If you use a mail-order pharmacy, please contact your pharmacy provider to confirm if this offer will be accepted.
Pharmacist Instructions for a Patient with an Eligible Third Party:
For Insured/Covered Patients: Submit the claim to the primary Third-Party Payer first, then submit the balance due to CHANGE HEALTHCARE as a Secondary Payer COB with patient responsibility amount and a valid Other Coverage Code of 8. This will reduce the eligible patient’s out-of-pocket costs to as low as $0 per 28-day supply for BYDUREON BCise® (exenatide extended-release) injectable suspension 2 mg subject to a maximum savings of $300 per 28-day supply. Patient out-of-pocket expenses may vary. Reimbursement will be received from CHANGE HEALTHCARE.
Pharmacist Instructions for Insured/Not Covered Patients: Submit the claim to the primary Third-Party Payer first. If the primary claim submission shows a managed care restriction (step-edit, prior authorization, or NDC block), continue the claim adjudication process and submit the balance due to CHANGE HEALTHCARE as a Secondary Payer COB with patient responsibility amount and a valid Other Coverage Code of 3. This will reduce eligible patient’s out-of-pocket costs by $150 per 28-day supply for BYDUREON BCise. Reimbursement will be received from CHANGE HEALTHCARE.
Pharmacist Instructions for a Cash-Paying Patient: Submit this claim to CHANGE HEALTHCARE. A valid Other Coverage Code (eg, 1) is required. The card will cover up to $150 per 28-day supply for BYDUREON BCise. 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 1-800-422-5604.
US-50877 Last Updated 3/21
BYDUREON BCise may cause serious side effects, including:
The most common side effects with BYDUREON BCise may include a bump at the injection site and/or nausea. Nausea is most common when you first start using BYDUREON BCise, but decreases over time in most people as their body gets used to the medicine.
Tell your healthcare provider about all of the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements, as taking them with BYDUREON BCise may affect how each medicine works.
Before using BYDUREON BCise, tell your healthcare provider if you are pregnant, nursing, or plan to become pregnant or nurse. BYDUREON BCise may harm your unborn baby.