Terms and Conditions

Please make sure you have read and agree with the Terms and Conditions

gammaCARE CO-PAY ASSISTANCE PROGRAM

TERMS AND CONDITIONS: 1. This offer is valid for commercially-insured patients and is good for use only with a gammaCore Sapphire or gammaCore-S prescription at the time the prescription is filled. 2. Depending on your insurance coverage, eligible insured patients will receive up to $100 of assistance for their monthly out of pocket costs for up to 12 months of treatment prescribed with a gammaCore Sapphire or gammaCore-S device. Check with your pharmacist or healthcare provider for your copay discount. Patient out-of-pocket expense may vary. 3. This offer is not valid for patients enrolled in Medicare, Medicaid, or other federal or state healthcare programs, including a state medical or pharmaceutical assistance program, or private indemnity or HMO insurance plans that reimburse you for the entire cost of your prescriptions or if you are covered by insurance in states that have an all-payer anti-kickback law or insurance that is paying the entire cost of the prescription. 4. Patients may not participate in this offer while receiving any additional co-pay assistance or charitable organization support for gammaCore. 5. Each offer is valid for up to 12 months of gammaCore Sapphire or gammaCore-S prescription treatment. An explanation of benefits statement must be faxed in before each use to verify the benefit needed. 6. Offer only valid for patients 18 or over. 7. Limit of 1 offer per patient. 8. electroCore reserves the right to rescind, revoke, or amend this offer without notice. 9. Offer good only in the USA, including Puerto Rico, at participating pharmacies or healthcare providers. 10. Offer void in Massachusetts. 11. Void if prohibited by law, taxed, or restricted. 12. This offer is not transferable. 13. This offer is not insurance. 14. By redeeming this offer, you acknowledge that you are an eligible patient and that you understand and agree to comply with the terms and conditions of this offer.

Veteran Customer Support

By participating in the gammaCore Support Program you authorize electroCore, Inc., the manufacturer of gammaCore to hold your personal information, including but not limited to, name, address, phone number, email, prescription details and related information you may disclose to electroCore (“Personal Information”). You understand that your Personal Information will be used by electroCore to provide you comprehensive support including training and assistance on how to use gammaCore, and reminders such as prescription refill reminders.

You understand that once your Personal Information is disclosed, it may no longer be protected by federal or state laws regarding patient privacy and it may be subject to re-disclosure without your permission. electroCore agrees to use your Personal Information only for the purposes described above or as permitted or required by law. electroCore will not use your Personal Information to market or promote products or services to you.

You may revoke your authorization at any time. Revoking your authorization will not affect the ability of electroCore to use Personal Information it received while the authorization was in effect. You may revoke your authorization at any time by written notice to:

electroCore, Inc.
200 Forge Way
Suite 205
Rockaway, NJ 07866

or by calling 1-888-903-CORE (2673) and following the instructions provided. This Authorization shall terminate upon conclusion of the gammaCore Support Program or earlier if required by applicable law.

gammaCore Sapphire^TM CV Customer Support

In connection with the continuing efforts of electroCore, Inc. to provide the best possible support to patients who have been prescribed gammaCore Sapphire™ CV by their healthcare provider, electroCore desires to obtain information from patients regarding their experience with gammaCore Sapphire CV, and to provide training and instruction on the use of gammaCore Sapphire CV. By electing to receive training and provide feedback on your experience with gammaCore Sapphire CV, you authorize electroCore, the manufacturer of gammaCore Sapphire™ CV, to hold your personal information, including but not limited to, name, address, phone number, email, prescription details and related information you may disclose to electroCore (“Personal Information”). You understand that your Personal Information will be used by electroCore solely to provide you training and assistance on how to use gammaCore Sapphire CV and to receive your feedback on your experience with gammaCore Sapphire CV. electroCore may use feedback you provide to improve support provided to other gammaCore Sapphire CV patients. Your information may be combined with the information of other gammaCore Sapphire CV patients in anonymized form for use in discussions with payers and insurance companies to try to obtain or improve reimbursement coverage for gammaCore Sapphire CV. electroCore will not use your Personal Information to market or promote products or services to you.

You understand that once your Personal Information is disclosed, it may no longer be protected by federal or state laws regarding patient privacy and it may be subject to re-disclosure without your permission. electroCore agrees to use your Personal Information only for the purposes described above or as permitted or required by law.

You may revoke your authorization at any time. Revoking your authorization will not affect the ability of electroCore to use Personal Information it received while the authorization was in effect. You may revoke your authorization at any time by written notice to:

electroCore, Inc.
200 Forge Way
Suite 205
Rockaway, NJ 07866

or by calling 1-888-903-CORE (2673) and following the instructions provided. This Authorization shall terminate upon conclusion of the gammaCore Support Program or earlier if required by applicable law.