Other Requirements

XARELTO withMe Coverage Gap Support is only available for people who are taking XARELTO^® as prescribed for FDA-approved, on-label use. It is not valid for any prescription written with off-label dosing.

XARELTO withMe Coverage Gap Support is not insurance and should not take the place of insurance.

To register, you must have insurance covering a portion of the cost for XARELTO^®, and you are being asked to pay more than $89 monthly for XARELTO^® through your insurance. The amount you pay ($89 or $250, plus sales tax if applicable) will not count toward your deductible or cumulative out-of-pocket spend. The amount you pay may not be submitted as a claim for payment to any third-party payer or pharmaceutical patient assistance foundation. If you choose, you may submit the amount you pay to a Flexible Spending Account (FSA) or a Health Savings Account (HSA). Check with your employer if the amount you pay may be submitted to a Health Reimbursement Account (HRA).

Registration begins April 1 each year and refills are available through December 31. Terms expire at the end of each calendar year and may change.

Before you register for XARELTO withMe Coverage Gap Support, it is important you understand that you will be asked to provide personal information that may include your name, address, phone number, email address, and information related to your prescription insurance and treatment. This information will be used by the mail-order pharmacy for Coverage Gap Support, in accordance with their privacy practices, to determine your eligibility, and, if eligible, enroll you in XARELTO withMe Coverage Gap Support, and administer XARELTO withMe Coverage Gap Support. The information will also be used to learn more about the people who use XARELTO withMe Coverage Gap Support and improve the information we give them. It will be shared with companies supporting XARELTO withMe Coverage Gap Support and your insurance provider, as required by law.

XARELTO withMe Coverage Gap Support may not be used with any other coupon, discount, prescription savings card, free trial, or other offer. Offer good only in the United States and its territories, including Puerto Rico. Void where prohibited or limited by law.

You may end your participation in XARELTO withMe at any time by calling 888-XARELTO (888-927-3586), Monday-Friday, 8 _AM to 8 _PM ET.