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WELCOME TO THE VYVGART CO-PAY PROGRAM

ELIGIBLE PATIENTS MAY RECEIVE VYVGART FOR $0

Depending on your insurance coverage, eligible patients may pay $0 for their VYVGART prescriptions. Check with your pharmacist or healthcare provider for your co-pay discount. Maximum savings limits apply; patient out-of-pocket expense will vary. Offer not valid for patients enrolled in Medicare, Medicaid, other federal or state healthcare programs, or where prohibited by law. See program Terms, Conditions, and Eligibility Criteria.

Please see full Prescribing Information for VYVGART and VYVGART HYTRULO, including Patient Information.

PLEASE ANSWER THE FOLLOWING QUESTIONS

Please select Yes or No.
Please select Yes or No.
Please select Yes or No.
Please select Yes or No.
Please select Yes or No.

By activating your VYVGART Co-Pay Offer, you certify that you are not enrolled in a federal government- or state government-funded prescription drug benefit program, such as Medicare, Medicaid, or any private indemnity or HMO insurance plan that reimburses you for the entire cost of your prescription drugs. You also certify that you are not Medicare-eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees. You further certify that should you begin receiving prescription benefits from one of these types of programs at any time, you will no longer participate in this co-pay program.

Please agree to this statement to participate in this program.

IF YOU HAVE ANY QUESTIONS ABOUT THE VYVGART CO-PAY PROGRAM, PLEASE CALL 1-800-753-4513.

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