Patients have two ways to save on their XACIATO prescription. Eligible commercially insured patients could pay as little as $25* through one of the following programs. Select below to jump to specific program sections and review the applicable terms and conditions.
Savings Program for XACIATO
Your patients could pay…
as little as $25*
This savings card may help your eligible patients save on the cost of treatment. The patient will present card at their local pharmacy with a prescription.
To participate in the Savings Program for XACIATO™ (clindamycin phosphate) vaginal gel 2% (“Program”), patients must present this card, along with a valid prescription for XACIATO, to their pharmacist. Patients with commercial health insurance who qualify to participate may pay as little as $25 per prescription, subject to the Terms and Conditions, stated below. If you have any questions regarding eligibility, the Terms and Conditions, or to discontinue participation, please call 1-877-264-2440 (8:00 AM-8:00 PM ET, Monday-Friday).
By clicking below to download the savings card, you are agreeing to the below Terms and Conditions, are commercially insured, and have a valid prescription for XACIATO.
Terms and Conditions
- Savings card is only valid for commercially insured patients 12 years of age or older who may pay as little as $25. Patients under the age of 18 years will require consent from a parent or guardian. Offer applies to out-of-pocket expenses (co-pay) greater than $25, up to a maximum of $300 per calendar year. After the maximum benefit, the patient will be responsible for the remaining monthly out-of-pocket costs.
- This savings card is not valid for cash-paying patients.
- This offer is not valid for prescriptions paid in part or in full by any federally or state-funded insurance program, including but not limited to Medicaid, Medicare, Veterans Affairs healthcare, Department of Defense, or TRICARE.
- This savings program cannot be combined with any other coupon, cash discount card, certificate, voucher, or similar offer.
- The savings card may be redeemed only once every 21 days.
- This savings card is not valid where the entire cost of the patient’s prescription is eligible to be reimbursed by a commercial insurance plan or other commercial health or pharmacy benefit program.
- The savings card is limited to 1 per person and is not transferable. No substitutions are permitted.
- The savings card is not insurance.
- You must be 18 years of age or older to redeem the savings card for yourself or a minor (other age restrictions may apply). Patient, guardian, pharmacist, and prescriber agree not to seek reimbursement for all or any part of the benefit received by the recipient through the offer. Patient or guardian is responsible for reporting receipt of savings card benefit to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the savings card, as may be required.
- The savings card can be used only by eligible residents of the United States at participating eligible retail or mail-order pharmacies in the United States.
- It is illegal to sell, purchase, trade, or counterfeit, or offer to sell, purchase, trade, or counterfeit the savings card. Void if reproduced.
- This savings card is not valid where prohibited by applicable laws, rules, or regulations. This savings card may not be available to patients in all states.
- Data related to your redemption of the savings card may be collected, analyzed, and shared with Organon and its affiliates and partners, for market research and other purposes related to assessing savings card programs. Data shared with Organon and its affiliates and partners will be aggregated and de-identified, meaning it will be combined with data related to other savings card redemptions and will not identify vou.
- ORGANON RESERVES THE RIGHT TO RESCIND, REVOKE, OR AMEND THIS PROGRAM AT ANY TIME WITHOUT NOTICE.
eVoucherRxTM Program for XACIATO
Eligible patients pay as little as $25†
Instant savings
- Automatic discount applied
at point-of-dispense
- No action required by HCPs,
patients, or pharmacists
- No digital or paper
coupons required
Over 50,000 participating pharmacies
- Many popular retail
pharmacies
Find an eVoucherRx pharmacy in your area
†Eligibility Criteria
By participating in this savings program, participants understand and agree that de-identified, non-personally identifiable information obtained from the pharmacy will be shared with the manufacturer. Participants also affirm that they
will not submit, and have not had submitted on their behalf, a claim for reimbursement or coverage for items purchased with this program under Medicaid, Medicare, TRICARE, or any other federal or state government health care program, or where prohibited by state law.
By participating in this savings program, you acknowledge and agree to the following terms and conditions:
- Commercially insured patients may pay as little as $25. Offer applies to out-of-pocket expenses (co-pay) greater than $25. Eligibility parameters and benefit limitations apply.
- Offer applies only to patients receiving XACIATO™ (clindamycin phosphate) vaginal gel 2% and associated refills.
- This offer is not valid for prescriptions paid in part or in full by any federally or state-funded program, including but not limited to Medicaid, Medicare, Department of Veterans Affairs, Department of Defense, or TRICARE, and where prohibited by law.
- This savings program cannot be combined with any other coupon, cash discount card, certificate, voucher, or similar offer.
- Offer good only in the United States at participating retail pharmacies and cannot be redeemed at government-subsidized clinics. Void where taxed, restricted, or prohibited by law.
- Offer not extended to clubs, groups, or organizations.
- Participation in this program must comply with all applicable laws and contractual or other obligations as a pharmacy provider.
- This is not an insurance program.
- Any step-edits or prior authorizations required by the insurance plan still apply.
- ORGANON RESERVES THE RIGHT TO MODIFY OR CANCEL THIS PROGRAM AT ANY TIME WITHOUT NOTICE.
- eVoucherRx™ is not extended on prescriptions for any of the following patients:
- who are cash-paying customers.
- using institution-based pharmacies to fill their prescriptions, or who are recipients of federal or state government health care.
- who are filling their prescriptions at non-participating pharmacies.
eVoucherRx™ is a trademark of RelayHealth.
HCP = health care professional.
