GELX Patient Copay Program

Available for eligible patients

What is the program?

The GELX Copay Program can help your patients pay as little as $25 and save up to $500 on their GELX prescription each month.

ELIGIBLE PATIENTS CAN PAY AS LITTLE AS $25 PER GELX PRESCRIPTION

AND SAVE UP TO $6,000 PER CALENDAR YEAR

Who is eligible?

  • Patients with a valid prescription for GELX
  • Patients who have commercial or private insurance coverage according to the terms and conditions of the program and are NOT enrolled in a government insurance plan (e.g. Medicare, Medicaid, TRICARE®, and other federal- or state-funded programs)

How does the patient access the GELX Copay Program?

Eligible patients can be enrolled in the GELX Copay Program upon benefits review with Onco360.

Terms and conditions for pharmacists
1. To be eligible, the patient must have minimum out-of-pocket costs greater than $26. An eligible patient will be responsible for any out-of-pocket costs above the maximum annual and monthly program benefit. 2. Amount of savings not to exceed $500 per month or $6,000 per calendar year. 3. The patient must be enrolled in the copay program before use. 4. The patient must have a current and valid prescription for GELX. 5. Offer is not valid if the patient is uninsured or paying cash for his/her prescription. 6. This manufacturer copay program is not valid for prescriptions reimbursed, in whole or in part, by Medicaid, Medicare, Medigap, VA, DoD, TRICARE, or any other federal or state healthcare programs, including where prohibited by the health insurance provider or by law. By accepting this benefit, the patient agrees not to submit a claim under these programs. 7. Offer is only valid for residents in the U.S., Puerto Rico, or U.S. Territories. 8. If the patient’s insurance situation changes, the pharmacist must notify the Copay Assistance Program immediately. 9. If the patient switches from private or commercial prescription benefit coverage to any government prescription benefit coverage (including medical assistance programs) the patient is no longer eligible for the program. 10. The patient agrees to comply with any and all terms of insurance contracting requiring notification regarding the existence and/or value of this offer. 11. Enrollment or use of this Copay card does not obligate the patient to use or continue to use GELX. 12. It is illegal to offer to sell, purchase, or trade this benefit. 13. Offer limited to one card per person and may not be combined with any other coupon, discount, prescription savings card, rebate, free trial, patient assistance, or other offer. Copayment assistance under this Program is not transferable. 14. US WorldMeds reserves the right to rescind, revoke, or amend this offer at any time without notice.

INDICATION

GELX ORAL GEL has a mechanical action indicated for the management of pain and relief of pain, by adhering to the mucosal surface of the mouth, soothing oral lesions of various etiologies, including: Oral Mucositis/Stomatitis (may be caused by chemotherapy or radiotherapy), irritation due to oral surgery, traumatic ulcers caused by braces or ill-fitting dentures, or disease. Also indicated for diffuse aphthous ulcers.

IMPORTANT SAFETY INFORMATION

  • GELX is contraindicated in any patient with a known history of hypersensitivity to any of the ingredients.
  • Patients should not use if stick pack has been opened prior to receipt or is damaged in any way.
  • Patients should not eat or drink for at least one hour after use.
  • If no improvement is seen in 7 days, patients are encouraged to consult their physician.

To report SUSPECTED ADVERSE REACTIONS or product complaints, contact US WorldMeds at 1-855-797-9232.
You may also report SUSPECTED ADVERSE REACTIONS to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch

Please see full Prescribing Information.

GELX is a registered trademark of Sunstar Suisse SA. USWM, LLC is the exclusive licensee and distributor of GELX in the United States and Its territories. All other trademarks are property of their respective owners.