Co-Pay Card Instructions | Avenova

Co-Pay Card Instructions

Co-Pay Coupon Card

Insured covered patients can receive their 40mL Avenova prescription for $35 or less using our Co-Pay Card. Those patients who are insured and not covered can receive their Avenova prescription for $60 or less. Co-Pay Card can be used for all commercially insured patients. 

Instructions

  • Submit the claim to the patient’s Third Party Payer first
  • Then submit the remaining balance to SimpleSaveRx as a Secondary Payer COB (coordination of benefits) with patient’s responsible amount and a valid OCC (other coverage code): e.g. 08.
  • Applicable discounts will be applied. Reimbursement will be received from SimpleSaveRx.
  • If you receive a rejection due to the patient being insured not covered and the pharmacy system allows, continue processing with OCC 03.
  • Call SimpleSaveRx at (844) 728-3479 for online processing help or questions.

Paper Claims

If you are unable to transmit this claim electronically, please process under your standard format for a “paper claim” submission. Paper claims are to be submitted to SimpleSaveRx, 3350 N Arizona Ave, Ste 2, Chandler, AZ 85225.

Restrictions

This coupon is not valid for prescriptions reimbursed under Medicare, Medicaid, or any other federal or state program, or where prohibited by law. Not valid with other offers. One coupon per pharmacy visit. Offer valid only for prescriptions filled in the United States and Puerto Rico. NovaBay Pharmaceuticals, Inc. reserves the right to discontinue this offer at any time. It is a violation of federal law to buy, sell, or counterfeit this certificate.