This Agreement (the “Agreement”) governs your (“Patient”) and the pharmacy’s (“Pharmacy,” “You” or “Your”) participation in the below-referenced program, the MyVTAMA Program (“Program”). The Program is offered by Organon LLC, a subsidiary of Organon & Co., Jersey City, New Jersey, U.S.A. (“Organon” or “the Company”). Throughout this Agreement, Organon and Pharmacy may be referred to individually as a “Party” or collectively as “Parties.”
WHEREAS, Organon offers the Program to Patients and Pharmacies.
NOW, THEREFORE, for good and valuable consideration, the sufficiency of which is hereby acknowledged, the Patient and Parties agree as follows:
Program Details:
The Program is brought to you by Organon. The Program is available for commercially insured patients. Patients who are enrolled in a government-run or government-sponsored healthcare plan with a pharmacy benefit are not eligible to use the MyVTAMA Patient Savings Card (“Card”).
This Card provides savings on out-of-pocket expenses for up to a 90-day supply of included Organon products, as described below. Maximum day supply limit may vary. If you have valid prescriptions for more than one Organon product, the copay expense and savings apply to each product. You may use this Card once every 25 days, depending on when you last received a 30-day supply of each Organon product.
Use of this Card does not obligate you to use or to continue using any Organon product. You may use this Card at any participating pharmacy located in the United States and Puerto Rico.
This Card may not be combined with any savings, discount, free trial, or other similar offer for the same prescription. This Card is not transferable and is void if reproduced. This Card is not health insurance. Limit one (1) Card per patient per use. This Card has no cash value and will not be accepted outside of participating pharmacies in the United States and Puerto Rico. Please visit Organon’s website for our privacy practices.
Use of this Card is subject to applicable state and federal law and is void where prohibited by law, rule, or regulation. In California, if a lower-cost FDA-designated therapeutically equivalent generic drug becomes available, or if the active ingredient is available without a prescription at a lower cost, this offer will become void for that Organon product.
Organon Legal:
Organon reserves the right to rescind, revoke, or amend these terms and conditions at any time, becoming effective upon publication at www.VTAMA.com/terms-conditions, and to deny payment for noncompliance with these terms in its sole discretion.
Terms and Conditions
Minimum out-of-pocket expenses:Eligible commercially insured patients are responsible for paying out-of-pocket expenses and any amount that exceeds the Organon payment for each prescription, as follows:
Use of this Card may be subject to limitations imposed by state or federal law, or by your health insurer. This Card is not valid where prohibited by law or by your health insurer.
The MyVTAMA program is only available for commercially insured patients. Patients enrolled in Medicare Part D, Medicaid, Medigap, VA, DoD, TRICARE, or any other government-run or government-sponsored healthcare program with a pharmacy benefit (“Government Beneficiary”) are not eligible to use the Card.
Patient Instructions:
You must present this card to the pharmacist along with your prescription each time you fill your prescription to participate in the Program. For questions or to discontinue participation, call Organon Savings Program customer support at 844-674-3200 (8:00 AM–7:00 PM ET, Monday–Friday).
By using this Card, you certify that you understand and will comply with the Program rules and terms set forth at www.VTAMA.com/terms-conditions.
- You are not a Government Beneficiary.
- No purchase is necessary, and there are no membership fees.
- You may not use this Card if prohibited by your insurer.
- You are responsible for reporting Card usage to your insurer as required.
By using this Card, you acknowledge that you currently meet the following eligibility criteria:
- You have a valid prescription for the applicable Organon product.
- You have no insurance or have a private insurance copay requirement.
- You are not a Government Beneficiary.
- You are at least 18 years old.
- You reside in the United States or Puerto Rico.
Pharmacist Instructions:
By accepting/using this Card, you certify that you have not and will not submit a claim for reimbursement under any government-run or government-sponsored healthcare program for this prescription.
- Submit transaction to Pharmacy Data Management Inc. (PDMI) using Bin #610020.
- Questions: Call PDMI at 1-800-800-7364.
- If commercial insurance exists, process it as primary and the Card as secondary (use COB segment).
- If no commercial insurance exists, you may run the Card for uninsured claims.
- Acceptance is subject to Apollo program terms at apollocare.com/Organon-copay-terms/.
- Do not apply the Card in California if a lower-cost equivalent drug is available.
No Warranties:
Pharmacy agrees that participation is voluntary and at its own risk. Organon, the Card administrator, and patients disclaim all warranties regarding the Program. Pharmacy is not entitled to compensation beyond the defined payment.
Indemnification:
Pharmacy will not represent Organon or its affiliates and will indemnify and defend Organon against claims resulting from Pharmacy’s negligence or misconduct.
Limitation of Liability:
Organon, its affiliates, and the Card administrator will not be liable for any damages, including direct, indirect, incidental, or consequential, related to the Program.
Audit and Review Rights:
Organon may audit Pharmacy records related to Program compliance with 15 days’ notice. Pharmacy must reimburse any erroneous payments and provide access within 15 business days.
Venue:
Participation constitutes an agreement with Organon in Texas. All legal disputes shall be handled exclusively in a state or federal court in Tarrant County, Texas.
Governing Law:
The Program is governed by the laws of the State of Texas, without regard to conflict of law principles.
To report negative side effects: Visit www.FDA.gov/MEDWatch or call 1-800-FDA-1088.
