Your DHIVY $50 Copay Card is ready to use. To ensure your savings is applied to your prescription out-of-pocket costs for DHIVY, please provide the information in the form below to your pharmacy. If you have any questions or issues regarding the use of this program, please call us at 1-833-378-7357.
To activate/generate your coupon, please answer the following questions:
Do you want to download or activate a DHIVY Instant Savings Card?
In order to redeem this offer you must have a valid prescription for DHIVY. Follow the dosage instructions given by the doctor. This offer may not be redeemed for cash. By using this offer, you are certifying that you meet the eligibility criteria and will comply with the terms and conditions described in the Restrictions section below. Patients with questions about the DHIVY $50 Copay Program offer should call 1-833-378-7357.
For any questions regarding online processing, call the Change Healthcare Help Desk at 1.800.433.4893.
This offer is valid in the United States. Offer not valid for prescriptions reimbursed under Medicaid, a Medicare drug benefit plan, Tricare or other federal or state health programs (such as medical assistance programs). Cash Discount Cards and other non-insurance plans are not valid as primary under this offer. If the patient is eligible for drug benefits under any such program, the patient cannot use this offer. By using this offer, the patient certifies that he or she will comply with any terms of his or her health insurance contract requiring notification to his or her payor of the existence and/or value of this offer. It is illegal to (or offer to) sell, purchase, or trade this offer. This offer is not transferable and is limited to one offer per person. Not valid if reproduced. Void where prohibited by law. Program administered by ConnectiveRx on behalf of Avion Pharmaceuticals. Avion Pharmaceuticals reserves the right to rescind, revoke or amend this offer without notice at any time.
DHIVY is a prescription medication that contains a combination of carbidopa and levodopa for the treatment of Parkinson’s disease, Parkinson’s disease caused by infection or inflammation of the brain, or Parkinson’s disease–like symptoms that may result from carbon monoxide or manganese poisoning.
DHIVY is contraindicated in patients