$10
per dose for
LUPANETA PACK
Up to $125 for a 1-month dose
Up to $250 for a 3-month dose
After the initial $10, you, the patient, are responsible for LUPANETA PACK prescription costs exceeding $125 for the 1-month dose and $250 for the 3-month dose.*
To see if you qualify for the Savings Card, fill out the form below.
(Answers to all questions are required, unless otherwise noted.)
*Eligibility: Available to patients in the United States with commercial prescription insurance coverage for LUPANETA PACK™ (leuprolide acetate for depot suspension and norethindrone acetate tablets) who meet eligibility criteria. Co-pay assistance program is not available to patients receiving prescription reimbursement under any federal, state or government-funded insurance programs (for example, Medicare (including Part D), Medicare Advantage, Medigap, Medicaid, TRICARE, Department of Defense or Veteran’s Affairs programs) or where prohibited by law or by the patient’s health insurance provider. If at any time a patient begins receiving prescription drug coverage under any such federal, state or government-funded healthcare program, patient will no longer be able to use the LUPANETA PACK card and patient must call 1-855-587-76631-855-587-7663 to stop participation. Patients residing in or receiving treatment in certain states may not be eligible. Patients may not seek reimbursement for value received from this card from any third-party payers. Offer subject to change or discontinuance without notice. Restrictions, including monthly maximums, may apply. This is not health insurance.
Good for out-of-pocket expenses up to $125 on your 3.75 mg LUPANETA PACK prescription after the initial $10 co-pay or up to $250 on your 3-Month 11.25 mg LUPANETA PACK prescription after the initial $10 co-pay and up to $25 for generic norethindrone acetate after the initial $5 co-pay on six occasions when accompanied with a prescription for LUPANETA PACK. AbbVie reserves the right to rescind, revoke, or amend this offer without notice. LUPANETA PACK is a registered trademark of AbbVie Inc. You may not combine this offer with any other rebate, coupon, free trial, or similar offer.
If your pharmacy isn't able to process your Savings Card for instant savings, you may still be eligible† to get LUPANETA PACK for as little as $10 per dose by receiving a rebate for the amount you paid out of pocket for your prescription. Simply download and fill out the Rebate Form, then mail it in or fax it to 1-908-548-09681-908-548-0968, along with your pharmacy or treatment receipt.
DownloadRebate Form
†Eligibility: Available to cash-paying patients and patients with commercial prescription insurance coverage for LUPANETA PACK (leuprolide acetate for depot suspension and norethindrone acetate tablets) in the United States who meet eligibility criteria. This assistance program is not available to patients receiving prescription reimbursement under any federal, state, or government-funded insurance programs (for example, Medicare [including Part D], Medicare Advantage, Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs programs) or where prohibited by law or by the patient’s health insurance provider nor may patients seek reimbursement for any payments made for LUPANETA PACK using any federal or state tax-exempt account (e.g., Health Savings Account, Flexible Spending Account, or Health Reimbursement Account). If at any time a patient begins receiving prescription drug coverage under any such federal, state, or government-funded healthcare program, patient will no longer be able to use the LUPANETA PACK Rebate and patient must call 1-855-587-76631-855-587-7663 to stop participation. Patients residing in or receiving treatment in certain states may not be eligible. Patients may not seek reimbursement for value received from this program from any third-party payers and assistance from this program may not be combined with any other rebate, coupon, free trial, or similar offer. Offer subject to change or discontinuance without notice. Restrictions, including monthly maximums, may apply. This is not health insurance.
LUPANETA PACK Patient Brochure
Read how LUPANETA PACK relieves endometriosis pain while reducing hot flashes and bone loss.
Help manage your endometriosis pain and certain side effects of leuprolide acetate for depot suspension with 1 prescription.1
Safety Considerations
- Do not take LUPANETA PACK™ if you are or may become pregnant; are breast-feeding; have undiagnosed uterine bleeding; a history of breast or other cancers; problems with blood clots; or stroke, heart attack, or liver problems
- Serious side effects may include thinning of bones which may not be completely reversible, vision problems (including sudden loss of vision, double vision, bulging eyes, or migraine headaches), depression or worsening of depression, and swelling (fluid retention)
- A condom, a diaphragm with contraceptive jelly, or a copper IUD is required to prevent pregnancy
- Increased endometriosis symptoms (such as pelvic pain or pressure and/or pain during intercourse) may occur for 1 or 2 weeks after starting therapy
- Reports of convulsions have occurred in patients taking leuprolide acetate
LUPANETA PACK INCLUDES
Leuprolide acetate for depot suspension
Helps manage endometriosis pain.
It comes as an injection your
healthcare
provider administers.
Norethindrone acetate tablets
Adds a small amount of progestin
to help with hot flashes and bone loss
associated with leuprolide
acetate.
Leuprolide acetate for depot suspension works by suppressing the hormones that feed endometriosis pain. Norethindrone acetate tablets (5 mg) won't interfere with the endometriosis pain relief that leuprolide acetate for depot suspension provides. Learn more.
comes in 1-month and 3-month doses with enough norethindrone acetate tablets for the number of days in the dose
1-month
Leuprolide acetate for depot suspension 3.75 mg injection + 30 daily norethindrone acetate 5-mg tablets
NDC 0074-1052-05
3-month
Leuprolide acetate for depot suspension 11.25 mg injection + 90 daily norethindrone acetate 5-mg tablets
NDC 0074-1053-05
Learn more about how leuprolide acetate for depot suspension + norethindrone tablets work.
- How norethindrone helps to reduce the hot flashes and bone density loss that occurs from leuprolide acetate for depot suspension therapy. Learn more.
Office Resources and Contact Information:
For additional resources, click here.