Access Support and Savings Options for Your JUBLIA Patients

Access and reimbursement

Letter of Medical Necessity*

When coverage is denied or restricted, a Letter of Medical Necessity (LMN) may support an appeal on behalf of your patient who has been prescribed JUBLIA. Use the downloadable LMN to document diagnosis, treatment history, and rationale for therapy.

Includes fields for patient information, diagnosis, prior therapies, and clinical rationale.
*NOTE: This sample form is provided for informational purposes only. As a reminder, it is the responsibility of the healthcare professional and/or their office staff, as appropriate, to determine the correct diagnosis, treatment protocol, and content of all such forms for each individual patient.

Help Eligible Patients Get JUBLIA With Ease Through the Ortho Dermatologics Rx Access Program

SAVINGS OPTIONS FOR YOUR ELIGIBLE† PATIENTS

Co-pay 0
Co-pay 65
Help Your Patients
Save on JUBLIA

Available exclusively at Walgreens and participating independent pharmacies.

†This offer is only valid for patients with commercial insurance and eligible uninsured patients. This offer is not valid for any person eligible for reimbursement of prescriptions, in whole or in part, by any federal, state, or other governmental programs, including, but not limited to, Medicare (including Medicare Advantage and Part A, B, and D plans), Medicaid, TRICARE, Veterans Administration or Department of Defense health coverage, CHAMPUS, the Puerto Rico Government Health Insurance Plan or any other federal or state health care programs. This offer is good only in the United States of America (including the District of Columbia, Puerto Rico and the U.S. Virgin Islands) at retail pharmacies owned and operated by Walgreen Co. (or its affiliates) and participating independent retail pharmacies. This offer is not valid in Massachusetts or Minnesota or where otherwise prohibited, taxed, or otherwise restricted. Go to OrthoRxAccess.com for full eligibility terms and conditions.

‡Insured not covered is defined as a patient who has commercial insurance but the drug is not covered on the plan’s formulary or has an NDC block, prior authorization, step edit or other restriction that has not been met.

Prices may vary for different product sizes.

§Not available for Medicare/Medicaid patients.

As Little As A $0 Co-Pay*

Exclusively at Walgreens and participating independent pharmacies

 View JUBLIA
complete cure results

*This offer is only valid for most eligible patients with commercial insurance. Eligible uninsured patients will pay more. This offer is not valid for any person eligible for reimbursement of prescriptions, in whole or in part, by any federal, state, or other governmental programs, including, but not limited to, Medicare (including Medicare Advantage and Part A, B, and D plans), Medicaid, TRICARE, Veterans Administration or Department of Defense health coverage, CHAMPUS, the Puerto Rico Government Health Insurance Plan, or any other federal or state health care programs. This offer is good only in the U.S. at retail pharmacies owned and operated by Walgreen Co. (or its affiliates) or participating independent retail pharmacies. This offer is not valid in Massachusetts or Minnesota or where otherwise prohibited, taxed or otherwise restricted. Click here for other terms and conditions that apply.

Indication

JUBLIA® (efinaconazole) topical solution, 10%, is indicated for the topical treatment of onychomycosis (tinea unguium) of the toenail(s) due to Trichophyton rubrum and Trichophyton mentagrophytes.

Important Safety Information

  • JUBLIA is for topical use only and is not for oral, ophthalmic, or intravaginal use.
  • Patients should be instructed to contact their health care professional if a reaction suggesting sensitivity or severe irritation occurs.
  • The most common adverse reactions (incidence ≥1%) were (vs vehicle): ingrown toenail (2.3% vs 0.7%), application-site dermatitis (2.2% vs 0.2%), application-site vesicles (1.6% vs 0%), and application-site pain (1.1% vs 0.2%).
  • JUBLIA should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus, and should be used with caution in nursing women. The safety and effectiveness in pediatric patients below 6 years of age have not been established.

To report SUSPECTED ADVERSE REACTIONS, contact Ortho Dermatologics at 1-800-321-4576 or the FDA at 1-800-FDA-1088 or visit www.fda.gov/medwatch.

Click here for full Prescribing Information.

References: 1. JUBLIA [prescribing information]. Bridgewater, NJ: Bausch Health US, LLC 2. Westerberg DP, Voyack MJ. Onychomycosis: Current trends in diagnosis and treatment. Am Fam Physician. 2013;88(11):762-770. 3. Gupta AK. Topical treatment of onychomycosis as a realistic option to systemic therapy. A case report. J Am Podiatr Med Assoc. 2014;104(1):115-117. 4. Data on file. Bausch Health US, LLC.

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INDICATION

JUBLIA® (efinaconazole) topical solution, 10%, is indicated for the topical treatment of onychomycosis (tinea unguium) of the toenail(s) due to Trichophyton rubrum and Trichophyton mentagrophytes.

IMPORTANT SAFETY INFORMATION

  • JUBLIA is for topical use only and is not for oral, ophthalmic, or intravaginal use.
  • Patients should be instructed to contact their health care professional if a reaction suggesting sensitivity or severe irritation occurs.
  • The most common adverse reactions (incidence ≥1%) were (vs vehicle): ingrown toenail (2.3% vs 0.7%), application-site dermatitis (2.2% vs 0.2%), application-site vesicles (1.6% vs 0%), and application-site pain (1.1% vs 0.2%).
  • JUBLIA should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus, and should be used with caution in nursing women. The safety and effectiveness in pediatric patients below 6 years of age have not been established.

To report SUSPECTED ADVERSE REACTIONS, contact Ortho Dermatologics at 1-800-321-4576 or the FDA at 1-800-FDA-1088 or visit www.fda.gov/medwatch.

Click here for full Prescribing Information.

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