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Do you have commercial or private health insurance?

YES

NO

Patients who don't have commercial or private insurance programs may be eligible for savings through the Synthroid Delivers Program, which oﬀers pricing as low as $25 a month with a 90-day prescription. Other pricing available for 30 and 60 days. The co-pay savings card is not available for patients who do not have commercial or private insurance.

Are you enrolled in or are your prescriptions paid for in part or full under any state or federally funded prescription insurance program, such as Medicare (including Part D), Medicare Advantage, Medicaid, Medigap, Veterans Affairs, The Department of Defense programs, or Tricare?

YES

NO

Patients enrolled in state or federally funded prescription insurance programs may be eligible for savings through the Synthroid Delivers Program, which oﬀers pricing as low as $25 a month with a 90-day prescription. Other pricing available for 30 and 60 days. The co-pay savings card is not available for patients enrolled in state or federally funded prescription insurance programs.

Get your co-pay savings card or enroll in the Synthroid Delivers Program to start saving today!

Select a delivery option below to receive your co-pay savings card.

Email

Item 1

To be emailed your savings code, please select an email address above.

Text

To be texted your savings code, please enter a mobile phone number above.

By checking the box, I authorize AbbVie and its third party contractors to send me autodialed text messages to the mobile phone number that I provided. I understand that I am not required to sign this consent, and that signing this consent is not a condition for me to purchase any product or services from AbbVie. I understand that standard message and data rates may apply. I understand that I can opt out at any time by texting "STOP" to 74366. Please refer to the Terms and Conditions.

The Synthroid Co-pay Savings Card is only available to patients with commercial prescription insurance coverage for Synthroid. The Synthroid Co-pay Savings Card is not available to patients receiving prescription drug coverage under any federal, state, or government-funded insurance program. If at any time you begin receiving prescription drug coverage under any federal, state, or government-funded program, you will no longer be eligible to participate in the Synthroid Co-pay Savings Card Program and you may no longer use the Synthroid Co-pay Savings Card.

Check this box to acknowledge your agreement with this statement

Terms and Conditions apply. This benefit covers SYNTHROID® (levothyroxine sodium). Eligibility: Available to patients with commercial insurance coverage for SYNTHROID who meet eligibility criteria. Co-pay assistance program is not available to patients receiving 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. If at any time a patient begins receiving drug coverage under any such federal, state, or government-funded healthcare program, patient will no longer be able to use the SYNTHROID Co-pay Savings Card and patient must call 1-866-627-4980 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 the SYNTHROID Co-pay Savings Program from any third-party payers. Offer subject to change or discontinuation without notice. Restrictions, including monthly maximums, may apply. Subject to all other terms and conditions, the maximum monthly benefit that may be available solely for the patient’s benefit under the co-pay assistance program is $15.00 per month during the calendar year for patients receiving SYNTHROID every month or $25.00 per month during the calendar year for patients receiving SYNTHROID every 3 months. The actual application and use of the benefit available under the co-pay assistance program may vary on a monthly, quarterly, and/or annual basis, depending on each individual patient’s plan of insurance and other prescription drug costs. This assistance offer is not health insurance. By redeeming this card, you acknowledge that you are an eligible patient and that you understand and agree to comply with the terms and conditions of this offer. To learn about AbbVie’s privacy practices and your privacy choices, visit https://privacy.abbvie

With the Synthroid Delivers Program, everyone with a Synthroid prescription pays the same price, every time, with no hidden out-of-pocket costs or price ﬂuctuations. You get brand-name Synthroid delivered right to your door, with pricing as low as $25 a month with a 90-day prescription. Other pricing available for 30 and 60 days. The program does not use or accept insurance.

Patients enrolled in state or federally funded prescription insurance programs may be eligible for savings through the Synthroid Delivers Program, which oﬀers pricing as low as $25 a month with a 90-day prescription. Other pricing available for 30 and 60 days. The co-pay savings card is not available to residents of California or Massachusetts.

Help us serve you better

Pill reminders

How would you like to receive pill reminders to take your medication? Please select one.

Email

Item 1

Text

By checking the box, I authorize AbbVie and its third party contractors to send me autodialed text messages to the mobile phone number that I provided. I understand that I am not required to sign this consent, and that signing this consent is not a condition for me to purchase any product or services from AbbVie. I understand that standard message and data rates may apply. I understand that I can opt out at any time by texting "STOP" to 74366. Please refer to the Terms and Conditions.

What time of day would you like to receive your pill reminders?

AM

PM

I understand that the information I’ve provided will be used only by AbbVie and its contracted third parties to contact me by mail, email, and phone with helpful information on my condition, SYNTHROID, and other AbbVie treatments, products, and services. To be REMOVED from our mailing list, go to SYNTHROID Unsubscribe or to request a COPY of the information, go to Contact Us.

Refill reminders

How would you like to receive your refill reminders? Please select one.

Email

Item 1

Text

By checking the box, I authorize AbbVie and its third party contractors to send me autodialed text messages to the mobile phone number that I provided. I understand that I am not required to sign this consent, and that signing this consent is not a condition for me to purchase any product or services from AbbVie. I understand that standard message and data rates may apply. I understand that I can opt out at any time by texting "STOP" to 74366. Please refer to the Terms and Conditions.

When would you like the refill reminders to start?

How often would you like to receive your refill reminders?

Every

I understand that the information I’ve provided will be used only by AbbVie and its contracted third parties to contact me by mail, email, and phone with helpful information on my condition, SYNTHROID, and other AbbVie treatments, products, and services. To be REMOVED from our mailing list, go to SYNTHROID Unsubscribe or to request a COPY of the information, go to Contact Us.

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