Sage Central
Patient Support

The program is designed to help reduce a patient’s eligible out-of-pocket copay costs related to the drug. Subject to certain terms and conditions, commercially insured patients may be eligible for copay assistance to help reduce their out-of-pocket, drug-related costs up to $15,000—regardless of income level.*

If you are eligible, the ZULRESSO Drug Copay Assistance Program will help reduce your out-of-pocket, drug-related costs for ZULRESSO up to $15,000.

* To be eligible to participate in the ZULRESSO^® Drug Copay Assistance Program (the “Drug Copay Program”), the patient must: (i) Have private, commercial health insurance; (ii) Reside in the United States or a U.S. territory; (iii) Be treated by a healthcare professional in the United States or a U.S. territory; (iv) Be 15 years of age or older; and (v) Be prescribed ZULRESSO^® (brexanolone) injection for an on-label diagnosis. The Drug Copay Program will cover the patient’s out-of-pocket costs (i.e., deductible, copay, or coinsurance obligations) for ZULRESSO up to a maximum of $15,000. The treating healthcare provider must itemize the out-of-pocket cost for the drug on the Copay Program Reimbursement Form for the patient to be eligible to receive financial assistance under the Drug Copay Program. The patient may not participate in the Drug Copay Program if the entire cost of the patients’ ZULRESSO prescription is reimbursable by her private insurance plan or other private health or pharmacy benefit programs. The patient may not participate in the Drug Copay Program if the patient is eligible for a state or federally funded insurance program, including but not limited to Medicare, Medicaid, TRICARE, Veterans Affairs health care, a state prescription drug assistance program, or the Government Health Insurance Plan available in Puerto Rico (formerly known as “La Reforma de Salud”). This offer is not valid for cash paying patients. The patient must deduct the value of assistance received from the Drug Copay Program from any reimbursement request submitted to her private insurance plan, either directly by the patient or on her behalf. The patient is responsible for reporting her participation in the Drug Copay Program to any private insurer, health plan, or other third party who pays for or reimburses any part of the prescription. The patient should not participate in the Drug Copay Program if her insurer or health plan prohibits use of manufacturer coupons/copay assistance. The patient savings under the Drug Copay Program cannot be combined with any other savings, free trial or similar offer for the drug. Claims must be submitted in a timely manner. An Explanation of Benefits (EOB) from the patient’s private insurance must be submitted within 180 days of the date of service for the patient to receive out-of-pocket assistance. The EOB must reflect the patient’s out-of-pocket cost for ZULRESSO and submission of the claim by the patient’s physician for the cost of the medication. The Drug Copay Program is not health insurance. This offer is not conditioned on any past or future purchases. Data related to the patient’s participation in the Drug Copay Program may be collected, analyzed, and shared with Sage Therapeutics, Inc. (“Sage”) for market research and other purposes related to assessing Sage’s patient support programs. Data shared with Sage will be aggregated and de-identified; it will be combined with data related to other Drug Copay Program use and will not identify the patient. In the event that the Drug Copay Program is terminated, the EOB must be submitted no more than 90 days after the termination date and EOB must be within the patient’s enrollment dates. Sage reserves the right to rescind, revoke or amend this offer without notice.

The program is designed to help reduce a patient’s eligible out-of-pocket copay costs related to the infusion. Subject to certain terms and conditions, commercially insured patients may be eligible for copay assistance to help reduce their out-of-pocket, infusion-related copay costs up to $2,000—regardless of income level.*

(Residents of Massachusetts and Rhode Island are not eligible for infusion assistance.)

If you are eligible, the ZULRESSO Infusion Copay Assistance Program will help reduce your out-of-pocket, infusion-related costs for ZULRESSO up to $2,000.

* To be eligible to participate in the ZULRESSO^® Infusion Copay Assistance Program (the “Infusion Copay Program”), the patient must: (i) Have private, commercial health insurance; (ii) Reside in the United States or a U.S. territory; (iii) Be treated by a healthcare professional in the United States or a U.S. territory; (iv) Be 15 years of age or older; and (v) Be prescribed ZULRESSO^® for an on-label diagnosis. The Infusion Copay Program will cover the patients’ out-of-pocket costs (i.e., deductible, copay, or coinsurance obligations) associated with the infusion of ZULRESSO (administration, needles, tubing, infusion bags, syringes, infusion pump, preparation of medication, IV access and room and board) up to a maximum of $2,000. The treating healthcare provider must itemize the out-of-pocket infusion costs on the Copay Program Reimbursement Form for the patient to be eligible to receive financial assistance under the Infusion Copay Program. Expenses not specifically related to the infusion of ZULRESSO are not eligible for assistance. The patient may not participate in the Infusion Copay Program if all costs of the drug infusion are reimbursable by the patient’s private insurance plan or other private health or pharmacy benefit programs. The patient may not participate in the Infusion Copay Program if the patient is eligible for a state or federally funded insurance program, including but not limited to Medicare, Medicaid, TRICARE, Veterans Affairs health care, a state prescription drug assistance program, or the Government Health Insurance Plan available in Puerto Rico (formerly known as “La Reforma de Salud”). Residents of the following states are not eligible to participate in the Infusion Copay Program: Massachusetts and Rhode Island. This offer is not valid for cash paying patients. Patient must deduct the value of assistance received from the Infusion Copay Program from any reimbursement request submitted to her private insurance plan, either directly by the patient or on her behalf. Patient is responsible for reporting her participation in the Infusion Copay Program to any private insurer, health plan, or other third party who pays for or reimburses any part of the prescription. The patient should not participate in the Infusion Copay Program if her insurer or health plan prohibits use of manufacturer-supported financial assistance. Claims must be submitted in a timely manner. An Explanation of Benefits (EOB) from the patient’s private insurance must be submitted within 180 days of the date of service for the patient to receive out-of-pocket assistance. The EOB must reflect the patient’s out-of-pocket cost for infusion of ZULRESSO and submission of the claim by the patient’s physician for the infusion costs. The patient savings under the Infusion Copay Program cannot be combined with any other savings, free trial or similar offer for the drug infusion. The Infusion Copay Program is not health insurance. This offer is not conditioned on any past, present or future purchases. Data related to the patient’s participation in the Infusion Copay Program may be collected, analyzed, and shared with Sage Therapeutics, Inc. (“Sage”) for market research and other purposes related to assessing Sage’s patient support programs. Data shared with Sage will be aggregated and de-identified; it will be combined with data related to other Infusion Copay Program use and will not identify the patient. In the event that the Infusion Copay Program is terminated, the EOB must be submitted no more than 90 days after the termination date and the EOB must be within the patient’s enrollment dates. Sage reserves the right to rescind, revoke or amend this offer without notice.