gammaCore Co-pay Assistance Program: Terms and Conditions

Please make sure you have read and agree with the Terms and Conditions for our Co-Pay Assistance Program

gammaCore Patient Registry Terms and Conditions

TERMS AND CONDITIONS: 1. This offer is valid for commercially-insured as well as cash paying patients and is good for use only with a gammaCore device prescription at the time the prescription is filled. 2. Depending on your insurance coverage, eligible insured and cash-paying patients will receive full coverage for their out of pocket costs on the gammaCore device only. Check with your pharmacist or healthcare provider for your copay discount. 3. This offer is not valid for patients enrolled in Medicare, Medicaid, or other federal or state healthcare programs, including a state medical or pharmaceutical assistance program or private indemnity or HMO insurance plans that reimburse you for the entire cost of your prescription drugs or you are covered by insurance in states that have an all-payer anti-kickback law or insurance that is paying the entire cost of the prescription. 4. Patient may not be enrolled in any additional co-pay assistance or charitable organizations for the device. 5. Each card is valid for 2 months of a gammaCore device prescription. An explanation of benefits statement must be faxed in before each use to verify the benefit needed. 6. Offer only valid for patients 18 or over. 7. Limit of 1 card per patient. 8. electroCore reserves the right to rescind, revoke, or amend this offer without notice. 9. Offer good only in the USA, including Puerto Rico, at participating pharmacies or healthcare providers. 10. Offer void in Massachusetts. 11. Void if prohibited by law, taxed, or restricted. 12. This card is not transferable. The selling, purchasing, trading, or counterfeiting of this card is prohibited by law. 13. This card is not insurance. 14. 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.

gammaCARE Co-Pay Assistance Program Terms and Conditions

TERMS AND CONDITIONS: 1.This offer is valid for commercially-insured as well as cash paying patients and is good for use only with a gammaCore device prescription at the time the prescription is filled. 2. Depending on your insurance coverage, eligible insured and cash-paying patients will receive up to $100 or assistance for their out of pocket costs on the gammaCore device only. Check with your pharmacist or healthcare provider for your copay discount. Patient out-of-pocket expense may vary. 3. This offer is not valid for patients enrolled in Medicare, Medicaid, or other federal or state healthcare programs, including a state medical or pharmaceutical assistance program or private indemnity or HMO insurance plans that reimburse you for the entire cost of your prescription drugs or you are covered by insurance in states that have an all-payer anti-kickback law or insurance that is paying the entire cost of the prescription. 4. Patient may not be enrolled in any additional co-pay assistance or charitable organizations for the device. 5. Each card is valid for 12 month, $100 per month, of a gammaCore device prescription. An explanation of benefits statement must be faxed in before each use to verify the benefit needed. The patient may reenroll after this 12-month period is up. 6. Offer only valid for patients 18 or over. 7. Limit of 1 card per patient. 8. electroCore reserves the right to rescind, revoke, or amend this offer without notice. 9. Offer good only in the USA, including Puerto Rico, at participating pharmacies or healthcare providers. 10. Offer void in Massachusetts. 11. Void if prohibited by law, taxed, or restricted. 12. This card is not transferable. The selling, purchasing, trading, or counterfeiting of this card is prohibited by law. 13. This card is not insurance. 14. 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.