GELX Copay Program

Available for eligible patients

PAY AS LITTLE AS $25 PER GELX PRESCRIPTION

AND SAVE UP TO $6,000 EACH YEAR

WHAT IS THE PROGRAM?

Eligible patients may pay as low as $25 per prescription of GELX

  • Amount of savings not to exceed $500 per month or $6,000 per calendar year

WHO IS ELIGIBLE?

Patients who:

  • Have a prescription for GELX
  • Have commercial or private insurance coverage
  • Are NOT enrolled in a government insurance plan (e.g. Medicare, Medicaid, TRICARE®, and other federal- or state-funded programs)

HOW DO I ENROLL?

Your Onco360 Benefits Verification Specialist will review your coverage and, if you are eligible, can enroll you in the GELX Copay Program

Terms and conditions for patients
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, you, the patient, agree 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. You agree 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 you 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

  • Do not use GELX if you are allergic to any of the ingredients.
  • Do not use if stick pack has been opened prior to receipt or is damaged in any way.
  • Do not eat or drink for at least one hour after use.
  • If no improvement is seen in 7 days, talk to your 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.