Eligibility:  Available to patients with commercial prescription insurance coverage for LUPRON DEPOT-PED who meet eligibility criteria.  Co-pay assistance program is not available to patients receiving prescription reimbursement under any federal, state or government-funded insurance programs (for example, Medicare (including Part D), Medicare Advantage, Medigap, Medicaid, TRICARE, Department of Defense or Veteran’s Affairs programs) or where prohibited by law or by the patient’s health insurance provider.  If at any time the patient begins receiving prescription drug coverage under any such federal, state or government-funded healthcare program, patient will no longer be able to use the LUPRON DEPOT-PED Instant Savings Card and patient must call 1-877-832-9755 to stop participation.  Patients residing in or receiving treatment in certain states may not be eligible.  Patients may not seek reimbursement for value received from the Instant Savings Card from any third-party payers.  Offer subject to change or discontinuance without notice.  Restrictions, including monthly maximums, may apply.  This is not health insurance.

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