![]() ![]() Organon will disclose the annual maximum as required by applicable law. ![]() The annual maximum shall be disclosed to each patient when the patient calls into the following number: 86. The annual maximum for each eligible patient is determined by Organon in its sole discretion and may be changed at any time and for any reason. The benefit available under the Co-pay Assistance Program is limited to the amount the patient’s private health insurance company indicates on the Explanation of Benefits ("EOB") that the patient is obligated to pay for the Program Product, less $5, up to an annual maximum. Patient must pay the first $5 of co-pay per administration of Program Product. ![]() Claim for Program Product must be submitted by health care provider to patient’s private health insurance separately from other services and products. It is not valid for any other out-of-pocket costs (for example, office visit charges or medication administration charges) even if such costs are associated with the administration of the Program Product. The benefit available under the Co-pay Assistance Program is valid for the patient’s out-of-pocket cost for the Program Product only.
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