Only patients with commercial insurance are eligible for the LILETTA Patient Savings Program.
Yes, the LILETTA Patient Savings Program can assist eligible commercially insured patients when the commercial insurance does not cover LILETTA. Please submit the insurance denial along with the requested documents for your claim submission. Please contact the LILETTA Patient Savings Program Help Desk 1.855.706.4508 if you have additional questions.
A representative from a specialty pharmacy may contact you about your LILETTA payment. Make sure to provide your savings card number (example: LILXXXXXXXX) and the Rx BIN# 014310 listed on your card.
No, the card may only be used toward the cost of the LILETTA product itself.
You can call 1.855.706.4508 between 9 AM—8 PM ET, Monday through Friday to obtain your account number over the phone.
If you paid your financial responsibility for LILETTA at the time of insertion, visit LILETTAcard.com to apply for the program and download a rebate request form. Once completed, submit your rebate request form along with your Explanation of Benefits to LILETTAcard.com or via fax at 1.888.683.4991. As per the Terms, Conditions, and Eligibility Criteria for the LILETTA Patient Savings Program, to be eligible for participation you must submit the EOB within 180 days of LILETTA insertion.
Yes. You may sign up today by starting the enrollment process on www.LILETTAcard.com. Once you receive your EOB, return to www.LILETTAcard.com to complete your application by uploading your EOB. Please note that you have 180 days from the date of insertion to complete your application (enrollment and EOB submission).
For the LILETTA® Patient Savings Program Help Desk, call 1.855.706.4508. Our fax number is 1.888.683.4991. We are available to answer questions from 9 AM—8 PM ET, Monday through Friday, except for the following holidays:
New Year's Day
LILETTA® (levonorgestrel-releasing intrauterine system) 52 mg is a hormone-releasing system placed in your uterus to prevent pregnancy for as long as you want for up to 6 years.
LILETTA does not protect against HIV or STDs.
Available by prescription only.
Please see full Prescribing Information.
Reference: 1. LILETTA (levonorgestrel-releasing intrauterine system) 52 mg [Prescribing Information]. Irvine, CA: Allergan and San Francisco, CA: Medicines360; 2020.