LUPRON DEPOT Rebate Program

Lupron Depot® Rebate Program

Cash-paying patients and commercially insured patients who cannot use the Lupron Depot® Co-pay Savings Card may be eligible for a rebate of up to $300 per month on their out-of-pocket cost for Lupron Depot® 3.75 mg. 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

  • Cash-paying patients and commercially insured patients who cannot use the Lupron Depot® Co-pay Savings Card.
  • Not valid for patients receiving prescription coverage through Medicare, Medicaid, TRICARE, or other government-funded programs.
  • Valid for treatment of endometriosis or anemia prior to uterine fibroid surgery.
  • Additional terms and restrictions apply.

How to Receive Your Rebate

  1. Visit LupronDepotSavingsCard.com and complete the eligibility questions.
  2. Download and complete the rebate form.
  3. Submit the rebate form with the required documentation, including your MDR pharmacy receipt.
  4. Allow approximately 2–4 weeks for processing.

Lupron Depot® Rebate Form

Download

For more information about this program, call 1-800-515-3784 or email info@mdrusa.com.