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Prescribing Information Important Risk Information
 
 
 

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Follow the LILETTA Patient Savings Program®* application steps below:

Step 1: Patient Information Release

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STEP 1: Patient Information Release

In order to participate in the LILETTA Patient Savings Program®, you must meet certain eligibility criteria. During the enrollment process for the program, you will be asked to provide personal information, such as your name, address, phone number, email address, and information related to your insurance and treatment. The information pertaining to you that we collect will be used in accordance with the AbbVie Privacy Statement, which can be found at www.AbbVie.com/privacy.

By enrolling in the LILETTA Patient Savings Program®, you agree that you would like to receive and that AbbVie and its affiliates and vendor partners may contact you with information related to LILETTA® and the LILETTA Patient Savings Program®, including site updates, education, and other AbbVie products, services, and programs. You may choose to be contacted by mail or email. If you later wish to opt out of receiving this information, you may cancel your enrollment in this program at any time by calling 1.855.706.4508.

AGREE

DISAGREE

*Depending on insurance coverage, eligible patients pay $100, then save up to a maximum of $750, for the first LILETTA product. Offer applies to product only, and does not apply to costs associated with medical examination or product administration. Check with your pharmacist or healthcare provider for your copay discount. Patient out-of-pocket expense may vary. Offer not valid for patients enrolled in Medicare, Medicaid, or other federal or state healthcare programs. Program expires 06/30/2023. Please see full LILETTA Patient Savings Program® Terms, Conditions, and Eligibility Criteria here.
LILETTA Patient Savings Program® Terms, Conditions, and Eligibility Criteria
  1. This offer is available to patients with commercial prescription insurance coverage for a valid prescription of LILETTA® (levonorgestrel-releasing intrauterine system) 52 mg prescription at the time the prescription is filled or after the product is administered to the patient.
  2. This offer is not valid for patients enrolled in Medicare, Medicaid, or other federal or state healthcare programs (including any state pharmaceutical assistance programs), or private indemnity or HMO insurance plans that reimburse you for the entire cost of your prescription drugs. Patients may not use this offer if they are Medicare-eligible and enrolled in an employer-sponsored health plan or medical or prescription drug benefit program for retirees. This offer is not valid for cash-paying patients. If at any time a patient begins receiving prescription drug coverage under any such federal, state or government-funded healthcare program, patient will no longer be eligible to use the LILETTA® Patient Savings Program.
  3. Depending on your insurance coverage, eligible patients pay $100, then save up to a maximum of $750 for the first LILETTA® product. Check with your pharmacist or healthcare provider for your copay discount. Patient out-of-pocket expense may vary.
  4. Each card is valid for one LILETTA® prescription, which must be filled or administered to the patient before the program expires on 06/30/2023. Savings requests and required supporting documentation must be submitted to www.LILETTAcard.com or faxed to 1.888.683.4991 within 180 days after the prescription is filled and the product is administered to the patient.
  5. AbbVie reserves the right to rescind, revoke, or amend this offer without notice.
  6. Offer good only in the USA, including Puerto Rico, at participating pharmacies or healthcare providers. Patients residing in or receiving treatment in certain states may not be eligible.
  7. Void where prohibited by law, taxed, or restricted.
  8. Patients may not seek reimbursement for value received from LILETTA® Savings Program from any third-party payers.
  9. This card has no cash value and may not be used in combination with any other discount, coupon, rebate, free trial, or similar offer for the specified prescription.
  10. This offer is not health insurance.
  11. This card expires June 30, 2023.
  12. By redeeming this card, you acknowledge that you are an eligible patient and that you understand and agree to comply with the terms and conditions of this offer.
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For patient assistance, please call 1.855.706.4508 Monday through Friday 9 AM-8 PM ET (except holidays). For healthcare provider or pharmacist assistance, please call the 24 hr/7 day a week help desk at 1.866.242.9104.

Program managed by ConnectiveRx on behalf of AbbVie.

 
Indication

LILETTA® (levonorgestrel-releasing intrauterine system) 52 mg is a hormone-releasing system placed in your uterus to prevent pregnancy for as long as you want for up to 6 years.

Important Risk Information About LILETTA

LILETTA does not protect against HIV or STDs.

Available by prescription only.

Please see full Prescribing Information.

Reference: 1. LILETTA (levonorgestrel-releasing intrauterine system) 52 mg [Prescribing Information]. Irvine, CA: Allergan and San Francisco, CA: Medicines360; 2020.