Terms & Conditions
Savings Card Terms & Conditions
Terms and Conditions: By using this offer, the patient certifies that he or she understands and will comply with all the following terms and conditions and any terms of his or her health insurance contract requiring notification to his or her payor of the existence and/or value of this offer.
Patient Eligibility Requirements: This offer is valid only for patients 18 years of age or older with private health insurance coverage. Patient must have a valid prescription for Auvelity® (dextromethorphan HBr and bupropion HCl) extended-release tablets 45mg/105mg at the time the prescription is filled by the pharmacist and dispensed to the patient. Patient must have private health insurance that provides coverage for some portion of the cost of AUVELITY. Patient is a resident of the United States or U.S. territories based on patient's address.
Important Restrictions: Offer not valid for prescriptions reimbursed under Medicaid, a Medicare drug benefit plan, Tricare or other federal or state health programs (such as medical assistance programs). Cash Discount Cards and other non-insurance plans are not valid as primary under this offer. Offer not valid for cash-paying patients. If the patient is eligible for drug benefits under any such program, the patient cannot use this offer. This offer is not transferable and is limited to one offer per person. Not valid if reproduced. Void where prohibited by law. Copay card cannot be combined with any other savings, free trial or similar offer for the specified prescription. Program managed by ConnectiveRx on behalf of Axsome Therapeutics, Inc.. The parties reserve the right to rescind, revoke or amend this offer without notice at any time. Program expires 12/31/2025.
To the Patient: Eligible patients will pay as little as $10 for 30- or 90-day supply. To redeem this offer you must have a valid prescription for Auvelity® (dextromethorphan HBr and bupropion HCl) extended-release tablets 45mg/105mg. Follow the dosage instructions given by the doctor. This offer may not be redeemed for cash. By using this offer, you are certifying that you meet the eligibility criteria and will comply with the terms and conditions described in the Restrictions section. Patients with questions about the Auvelity® On My Side Savings Offer should call 1-800-805-8621.
To the Pharmacist: When you apply this offer, you are certifying that you have not submitted a claim for reimbursement under any federal, state, or other governmental programs for this prescription. Participation in this program must comply with all applicable laws and regulations as a pharmacy provider. By participating in this program, you are certifying that you will comply with the terms and conditions described in the Restrictions section.
Mobile Terms & Conditions
SMS (text) messages are recurring automated copay program messages, which may include savings alerts, refill reminders, and other messages related to your participation in the copay program. These SMS messages are sent through PSKW, LLC dba ConnectiveRx, a service provider partner operating on behalf of Axsome.
When you opt-in to the service, we will send you an SMS message to confirm your signup. By providing your cell phone number, you represent that you are the authorized user of the wireless device you use to receive the messages and that you are authorized to approve any changes. Axsome reserves the right to alter these terms and conditions or discontinue the messaging at any time and at its sole discretion, may add or delete a cellular carrier from this program at any time, without notice. Text messages you receive as part of this program are automated and your responses are not read by any person. Consent to receiving SMS messages is not a requirement to participate in the AUVELITY Savings Program and you may opt out at any time. Please visit Axsome’s privacy notice or contact us for additional information. Please see the full Terms and Conditions regarding participation eligibility in the AUVELITY Savings Program.
Message and data rates may apply. While we do not charge you for the messages, your mobile service provider may charge you for SMS text messages as a part of your contract or service. Please contact your mobile service provider for details.
Message frequency varies.
To stop receiving messages, reply STOP at any time. For help, reply HELP or call 1-800-805-8621.
We are able to deliver on most of the major and minor carriers: i.e Verizon, Sprint, AT&T, T-Mobile and MetroPCS. If you are unsure whether your carrier supports short codes, please contact your wireless provider directly.
***Carriers are not liable for delayed or undelivered messages***
Call your healthcare provider (HCP) or get emergency help right away if you or your loved one have any of the following symptoms, especially if they are new, worse, or worry you:
- suicidal thoughts or actions
- new or worsening depression or anxiety
- agitation or restlessness
- trouble sleeping (insomnia)
- acting aggressive, being angry, or violent
- an extreme increase in activity and talking (mania)
- panic attacks
- new or worsening irritability
- acting on dangerous impulses
- other unusual changes in behavior or mood
- have or had a seizure disorder.
- have or had an eating disorder like anorexia or bulimia.
- have recently and suddenly stopped drinking alcohol or use medicines called benzodiazepines, barbiturates, or anti-seizure medicines, and you have recently suddenly stopped taking them.
- are taking a monoamine oxidase inhibitor (MAOI), have stopped taking an MAOI in the last 14 days, or are being treated with the antibiotic linezolid or intravenous methylene blue. Ask your HCP or pharmacist if you are unsure whether you take an MAOI. Do not start taking an MAOI until you have stopped taking AUVELITY for at least 14 days.
- are allergic to dextromethorphan, bupropion, or any other ingredients in AUVELITY.
- greatly increased energy
- racing thoughts
- unusually grand ideas
- talking more or faster than usual
- severe trouble sleeping
- reckless behavior
- excessive happiness or irritability
- agitation
- hallucinations
- confusion
- coma
- fast heartbeat
- blood pressure changes
- dizziness
- sweating
- flushing
- high body temperature (hyperthermia)
- shaking (tremors), stiff muscles, or muscle twitching
- loss of coordination
- seizures
- nausea, vomiting, diarrhea
COMMON SIDE EFFECTS
The most common side effects of AUVELITY include dizziness, headache, diarrhea, feeling sleepy, dry mouth, sexual function problems, and excessive sweating.BEFORE USING
- Tell your HCP about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
- It is important to tell your HCP if you are taking:
- other medicines containing bupropion or dextromethorphan
- medicines to treat depression, anxiety, psychotic or thought disorders, including selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants
- theophylline
- corticosteroids
- oral diabetes medicines or use insulin to control your blood sugar
- medicines to control appetite (anorectic)
- nicotine medicines to help you stop smoking
- street (illicit) drugs
- benzodiazepines, sedative-hypnotic (sleep medicines), or opiates
- If you are unsure if you take any of these medicines, ask your HCP. They can tell you if it is safe to take AUVELITY with your other medicines.
- Tell your HCP if you are pregnant or plan to become pregnant. AUVELITY may harm your unborn baby if you take it during pregnancy. AUVELITY is not recommended during pregnancy. Your HCP will prescribe another treatment for females who plan to become pregnant.
- One of the ingredients in AUVELITY passes into your breast milk. Do not breastfeed during treatment with AUVELITY and for 5 days after the final dose.
- have problems with your liver or kidneys.
- have diabetes, heart disease, or high blood pressure.
- have a history of seizure, stroke, eating disorder, head injury, or have a tumor in your brain or spinal cord.
- have a history of alcohol or drug abuse.
- have a history of seizure, eating disorder, or abuse alcohol or drugs.
- have low blood sugar, low blood sodium levels, or a history of falls.
- you take certain other medicines that could interact with AUVELITY.
- have or had a condition known as bipolar disorder, a family history of bipolar disorder, suicide, or depression.
- have high pressure in the eye (glaucoma).
- you drink a lot of alcohol.
- you abuse prescription or street drugs.
- you are pregnant or plan to become pregnant.
- you are breastfeeding or plan to breastfeed.
HOW TO TAKE
- AUVELITY is available by prescription only.
- Take AUVELITY exactly as instructed by your HCP.
- Take AUVELITY 1 time a day for 3 days, then increase your dose to 2 times a day (taken at least 8 hours apart). Do not take more than 2 AUVELITY tablets in 24 hours.
- If you miss a dose, do not take an extra dose. Wait and take your next dose at the regular time. Do not take more than 1 dose of AUVELITY at a time.
- Do not change your dose or stop taking AUVELITY without talking to your HCP.
- Swallow AUVELITY tablets whole. Do not crush, chew, or divide the tablets.
- Do not give AUVELITY to other people.
- If you take too much AUVELITY call your HCP or seek medical advice promptly.
WHAT IS AUVELITY (aw-VEHL-ah-tee)?
WHAT IS THE MOST IMPORTANT INFORMATION I SHOULD KNOW ABOUT AUVELITY?
Call your healthcare provider (HCP) or get emergency help right away if you or your loved one have any of the following symptoms, especially if they are new, worse, or worry you:
- suicidal thoughts or actions
- new or worsening depression or anxiety
- agitation or restlessness
- trouble sleeping (insomnia)
- acting aggressive, being angry, or violent
- an extreme increase in activity and talking (mania)
- panic attacks
- new or worsening irritability
- acting on dangerous impulses
- other unusual changes in behavior or mood
- have or had a seizure disorder.
- have or had an eating disorder like anorexia or bulimia.
- have recently and suddenly stopped drinking alcohol or use medicines called benzodiazepines, barbiturates, or anti-seizure medicines, and you have recently suddenly stopped taking them.
- are taking a monoamine oxidase inhibitor (MAOI), have stopped taking an MAOI in the last 14 days, or are being treated with the antibiotic linezolid or intravenous methylene blue. Ask your HCP or pharmacist if you are unsure whether you take an MAOI. Do not start taking an MAOI until you have stopped taking AUVELITY for at least 14 days.
- are allergic to dextromethorphan, bupropion, or any other ingredients in AUVELITY.
- greatly increased energy
- racing thoughts
- unusually grand ideas
- talking more or faster than usual
- severe trouble sleeping
- reckless behavior
- excessive happiness or irritability
- agitation
- hallucinations
- confusion
- coma
- fast heartbeat
- blood pressure changes
- dizziness
- sweating
- flushing
- high body temperature (hyperthermia)
- shaking (tremors), stiff muscles, or muscle twitching
- loss of coordination
- seizures
- nausea, vomiting, diarrhea
COMMON SIDE EFFECTS
The most common side effects of AUVELITY include dizziness, headache, diarrhea, feeling sleepy, dry mouth, sexual function problems, and excessive sweating.BEFORE USING
- Tell your HCP about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
- It is important to tell your HCP if you are taking:
- other medicines containing bupropion or dextromethorphan
- medicines to treat depression, anxiety, psychotic or thought disorders, including selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants
- theophylline
- corticosteroids
- oral diabetes medicines or use insulin to control your blood sugar
- medicines to control appetite (anorectic)
- nicotine medicines to help you stop smoking
- street (illicit) drugs
- benzodiazepines, sedative-hypnotic (sleep medicines), or opiates
- If you are unsure if you take any of these medicines, ask your HCP. They can tell you if it is safe to take AUVELITY with your other medicines.
- Tell your HCP if you are pregnant or plan to become pregnant. AUVELITY may harm your unborn baby if you take it during pregnancy. AUVELITY is not recommended during pregnancy. Your HCP will prescribe another treatment for females who plan to become pregnant.
- One of the ingredients in AUVELITY passes into your breast milk. Do not breastfeed during treatment with AUVELITY and for 5 days after the final dose.
- have problems with your liver or kidneys.
- have diabetes, heart disease, or high blood pressure.
- have a history of seizure, stroke, eating disorder, head injury, or have a tumor in your brain or spinal cord.
- have a history of alcohol or drug abuse.
- have a history of seizure, eating disorder, or abuse alcohol or drugs.
- have low blood sugar, low blood sodium levels, or a history of falls.
- you take certain other medicines that could interact with AUVELITY.
- have or had a condition known as bipolar disorder, a family history of bipolar disorder, suicide, or depression.
- have high pressure in the eye (glaucoma).
- you drink a lot of alcohol.
- you abuse prescription or street drugs.
- you are pregnant or plan to become pregnant.
- you are breastfeeding or plan to breastfeed.
HOW TO TAKE
- AUVELITY is available by prescription only.
- Take AUVELITY exactly as instructed by your HCP.
- Take AUVELITY 1 time a day for 3 days, then increase your dose to 2 times a day (taken at least 8 hours apart). Do not take more than 2 AUVELITY tablets in 24 hours.
- If you miss a dose, do not take an extra dose. Wait and take your next dose at the regular time. Do not take more than 1 dose of AUVELITY at a time.
- Do not change your dose or stop taking AUVELITY without talking to your HCP.
- Swallow AUVELITY tablets whole. Do not crush, chew, or divide the tablets.
- Do not give AUVELITY to other people.
- If you take too much AUVELITY call your HCP or seek medical advice promptly.