Take your pick of these Horizant® resources

Access resources that provide more information on Horizant® for you and your patients, including copay savings details

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Match patients with the right savings program for their needs

Reduce patients’ out-of-pocket costs through one of our many savings programs.
If eligible, patients can access savings regardless of insurance coverage

E-Z Rx logo

Azurity Solutions E-Z Rx™

  • If you’re commercially insured, the Azurity Solutions E-Z Rx program lets eligible* patients pay as little as $0 per month through our premier independent pharmacy network.
  • Get connected to one of the E-Z Rx pharmacies near you through our pharmacy locator.

*Patients enrolled in state/federal programs (Medicare, Medicaid, VA/DOD, etc.) are not eligible for copay discount savings through Azurity Solutions E-Z Rx or any Azurity Instant Savings Card.

Copay Savings Card

  • If you’re a commercially insured patient and eligible for the program, use our Copay Savings Card and pay as little as $0 per month. Use these instant savings at any pharmacy of your choice.
Request a Card

Horizant® Copay Savings Card

Patient: Eligible commercially insured patients may receive their first prescription of Horizant® 600 mg or 300 mg for as little as $0. For questions regarding your eligibility or benefits or if you wish to discontinue your participation, call 1-855-700-2990 (8 ᴀᴍ–8 ᴘᴍ ET, Monday–Friday).

Alternatively, cash-paying patients and patients with commercial insurance who are not eligible for the $0 copay and choose not to participate in the Azurity Solutions Patient Direct Program are allowed 1 fill per calendar year and will pay as little as $100 for up to 30 tablets.

Pharmacist: Benefit limitations apply. When you use this card, you are certifying that you have not submitted and will not submit a claim for reimbursement under any federal, state, other governmental programs, or drug discount card for this prescription. By redeeming this coupon, you agree that you understand and will abide by the terms and conditions of this offer, posted at www.mckesson.com/mprstnc

  • Submit transaction to McKesson Corporation using BIN #610524
  • Patient not eligible if prescriptions are paid in part or full by any state or federally funded programs, including but not limited to Medicare, Medigap, VA, DOD, or Tricare. This program is not valid where prohibited by law
  • If primary coverage exists, input card information as secondary coverage and transmit using the COB segment of the NCPDP transaction. Applicable discounts will be displayed in the transaction response
  • Acceptance of this card and your submission of claims for the Horizant® Copay Savings Card program are subject to the Horizant® Savings Card Program Terms and Conditions posted at www.mckesson.com/mprstnc
  • LoyaltyScript® is not an insurance card

For questions regarding setup, claim transmission, patient eligibility, or other issues, call 1-855-700-2990 (8 ᴀᴍ–8 ᴘᴍ ET, Monday–Friday).

Not intended for distribution to healthcare providers in Vermont.

  • GoodRx offers a discounted cash price regardless of insurance coverage.
    • Pick up in pharmacy
    • Cash-only savings
    • All patients eligible
    • No insurance required

RLS resources

Letter of Medical Necessity

This template may help in cases requiring a Letter of Medical Necessity.

Checklist for Prior Authorization (PA) Submission

This checklist may help guide your office and staff through the PA submission process.

Medical Necessity Letter: The draft letter presented here is for informational purposes only and is not intended to provide reimbursement or legal advice. Azurity Pharmaceuticals does not guarantee that the use of any information provided in this letter will result in coverage or payment by any third-party payer. You are responsible for the submission based on your clinical judgment and your knowledge of the patient’s unique situation.