UBRELVY Financial Assistance Guide

This category includes insurance plans provided through an employer, purchased with subsidy support from the Affordable Care Act (Obamacare) or purchased privately.

Highlights of UBRELVY Savings Card

If you have commercial drug insurance, you may pay $0 for your first fill of UBRELVY. Reasons why your out-of-pocket cost may differ:

• A savings card was not used
• The plan deductible hasn’t been met
• Not all health insurance plans are the same and they may have different rules and benefits

Steps To Get Your Savings Card

1. Your doctor writes you a prescription for UBRELVY.
2. Obtain a Savings Card online at ubrelvy.com/savings or by texting UBRELVY to 48764.
3. Take your prescription (if your doctor did not call it in to your pharmacy) and Savings Card to your regular retail pharmacy to be filled. The Savings Card includes important information you need to provide the pharmacist to connect your prescription to the offered savings. If you have any trouble please call 1-844-UBRELVY (1-844-482-7358).
4. To activate your Savings Card online visit ubrelvy.com/savings. choose “Activate an Existing Card”. You will then be prompted to complete the following steps:

1. 1. Answer the Savings Card eligibility questions – please confirm that you are a resident of the US or Puerto Rico, NOT enrolled in a government-funded prescription program.
   2. Provide your contact information, gender and date of birth.
   3. Read and accept the terms and conditions for each disclosure.
   4. You will receive an email with your Savings card information. Be sure to save this and show it to your Pharmacist. You can also activate a card via SMS; simply text UBRELVY to 48764.

Congratulations on accessing your first dose of UBRELVY! Contact your doctor’s office to see if they have completed the UBRELVY prior authorization form on your behalf and your insurance company to see if they will be covering your prescribed medicine. If you have questions or encounter problems contact U-Concierge at 1-844-4UBRELVY.

The average cost for a 30-day supply of UBRELVY is $24.

To see if you qualify for the Extra Help program, click here.

Reasons why your monthly cost may differ:

• A lack of supplemental coverage (Part D)
• The benefit varies during different coverage phases of most Part D plans
• Not all Part D plans are the same and they may have different rules and benefits

$2.43 is the average cost for a 30-day supply of UBRELVY.

Reasons why your monthly cost may differ:

• Household income could play a role in determining your monthly cost
• Out-of-pocket charges vary from state to state

Refer to your state agency for details about Medicaid out-of-pocket costs. Or visit Medicaid.gov

If you are having difficulty paying for your medicine, AbbVie may be able to help. Visit AbbVie.com/myAbbVieAssist to learn more.

The Patient Advocate Foundation (a CHAMP participant organization) can be a helpful resource for patients and caregivers who are experiencing access challenges. PAF provides a suite of expert tips to help navigate insurance denials, appeals and common barriers at: patientadvocate.org/migrainematters.

PAF also offers one-on-one case management assistance through its dedicated Migraine Careline for people living with migraine who experience access challenges. The Migraine Careline provides assistance with: navigating eligibility and enrollment in disability benefits; overcoming insurance coverage; and financial burdens that impact patient access to care.

All services are completely free and provided through phone and/or email communication. Visit migraine.pafcareline.org or call 866-688-3625 to speak with a case manager today.