Lupron Depot® Rebate Program
Cash-paying patients are eligible for a rebate of up to $300 per month on their out-of-pocket costs for Lupron Depot® (leuprolide acetate for depot suspension) 3.75mg. Also, patients with insurance coverage for Lupron Depot® who are unable to utilize the Lupron Depot Co-pay Savings Card for instant savings are eligible to submit for co-pay reimbursement of up to $300 per month.
Eligible Medications
- Lupron Depot® (leuprolide acetate for depot suspension) 3.75mg
Eligibility Requirements
- Valid for cash-paying patients who have commercial insurance but do not have coverage for Lupron Depot®
- Valid for patients with commercial insurance coverage for Lupron Depot® who are unable to utilize the Lupron Depot® Co-pay Savings Card
- Not valid for patients receiving prescription reimbursement under any federal, state, or government funded insurance plan.
- Indication for endometriosis or anemia prior to uterine fibroid surgery
Enrollment Instructions
- Go to www.luprondepotsavingscard.com.
- Answer the questions by selecting your indication and confirming that you have commercial insurance coverage.
- Download the savings card. You will need the RxGrp and RxID numbers from the front of the card when filling out the rebate form.
- Download and fill out the rebate form.
- 5Mail in the rebate form, email it to claim.support@iqvia.com, or fax it to (908) 548-0968 along with copies of your MDR pharmacy receipt and your insurance card.
- You will receive your rebate check by mail in approximately 1-2 weeks.
Lupron Depot® Rebate Form
For more information about this program, call 1-800-515-3784 or email info@mdrusa.com.