Copay Assistance Program Terms and Conditions
The Kiniksa Pharmaceuticals Copay Assistance Program (the “Program”) can offer eligible patients savings on their prescriptions for Kiniksa medicine.
- The patient has commercial prescription drug insurance that covers the medicine.
- The Program is not available for patients whose prescription claims are eligible to be reimbursed, in whole or in part, by any governmental program, such as patients enrolled in Medicare Part D and patients whose prescription is paid for by Medicare, Medicaid, Medigap, CHAMPUS, Department of Defense (DoD), TRICARE, Veterans Affairs (VA), Children’s Health Insurance Program (CHIP), the Indian Health Service, or any other federal or state pharmaceutical assistance program.
- The Program is not available if a patient is uninsured or paying cash for the medicine.
- This Program is not available if the commercial prescription drug insurance reimburses for the entire cost of the medicine.
- The patient lives in the U.S. or a U.S. territory.
- The patient has a valid prescription for the medicine for an FDA-approved indication.
Where reimbursement covers a portion of the prescription, the Program is valid only for the amount of the actual out-of-pocket cost (up to the maximum amount offered through the Program). The Program is not health insurance and it may not be combined with any other program, rebate, coupon, or offer. No claim for reimbursement for all or any part of the benefit received by the patient through the Program may be submitted to anyone, including an insurance source.
Additional eligibility requirements and program terms and conditions apply. Kiniksa Pharmaceuticals reserves the right to rescind, revoke, or amend the Program at any time without notice.
The Kiniksa One Connect team will evaluate and determine if a patient is eligible for the Program. The Program may not apply in certain states. Contact the Kiniksa One Connect team at 1-833-KINIKSA (1-833-546-4572) for additional information.