Ozempic^® Pen

By continuing and using this offer, you agree that this offer is for self-pay patients only and confirm that you are a resident of the United States or a United States Territory (Puerto Rico, Guam, U.S. Virgin Island, Northern Mariana Islands, American Samoa) who is 18 years of age or older and have a valid prescription for the brand covered under this program.

Further, you (and anyone else acting on your behalf) agree that if you have any state, federal, or government healthcare programs (examples include but are not limited to Medicare, Medicare Part D, a Medicare Advantage Prescription Plan, insurance through US Veterans Affairs (VA), US Department of Defense (DOD), TRICARE, Medicaid), any other state or federal healthcare reimbursement account, or any other third party payer (private or otherwise), you must (1) not ask your insurance to pay you back for the money that you self-paid for your medication using this offer; (2) cannot attempt to count the cost of this medicine toward your insurance deductible or out-of-pocket limit; and (3) If you are asked by your insurance company about this prescription, you must tell your insurance company that you bought this medicine outside of its prescription plan using the Ozempic® self-pay offer and that you are not seeking reimbursement or submitting a claim for this prescription.

The purchase of the prescription under this program is not conditioned on current or any future purchases of Ozempic® or any other items or services that could become billable to any Government Program.