Rebate Card

Download and print your savings card by clicking the button below:

How to Redeem

1. When you fill your prescription, show this savings card to the pharmacist and receive your discount. The pharmacist should process your insurance first, which may require a prior authorization, and this rebate second.
2. Keep this savings card with you for future refills. The card is valid for 13 uses.

*Eligible patients receive savings.

Program Terms, Conditions, and Eligibility Criteria:

  1. Novan takes active measures to ensure pharmacies utilize this program in an authorized manner. By using this card, you certify you have read, understood and comply with the terms, conditions and RESTRICTIONS below.
  2. This offer is valid only for eligible patients and is good for use only with a valid prescription for Rhofade, Sitavig, Cloderm, clocortolone pivalate, and Minolira at the time the prescription is filled by the pharmacist and dispensed to the patient.
  3. Depending on your insurance coverage, eligible patients may pay as little as $0 for up to 13 prescription fills. Check with your pharmacist for your co-pay discount. Maximum savings limit applies; patient out-of-pocket expense may vary.
  4. This offer is not valid for use by patients enrolled in 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 other federal or state programs (including any state pharmaceutical assistance programs), or private indemnity or HMO Insurance plans that reimburse you for the entire cost of your prescription drugs, or where otherwise prohibited, taxed or otherwise restricted. Patients may not use this offer if they are Medicare eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees.
  5. Each card is valid for up to 13 prescription fills.
  6. Novan reserves the right to rescind, revoke, or amend this offer without notice.
  7. Offer good only in the US at participating retail pharmacies and cannot be redeemed at government subsidized clinics.
  8. Void if prohibited by law, taxed, or restricted.
  9. This card is not transferable. The selling, purchasing, trading, or counterfeiting of this card is prohibited by law.
  10. This card has no cash value and may not be used in combination with any non-insurance, other discount coupon, discount card, rebate, free trial, or similar offer for the specified prescription.
  11. This offer is not health insurance.
  12. By redeeming this card, you acknowledge that you are an eligible patient and that you understand and agree to comply with the terms and conditions of this offer. For questions about this program, please call 1-855-631-2485.

Pharmacist Instructions for a patient with an eligible third-party payer:

  1. When you redeem this card, you certify that you have not submitted and will not submit a claim for reimbursement under any federal, state, or other government programs for this prescription.
  2. Submit the claim to the primary third-party payer first and then submit the balance due to Change Healthcare as a Secondary Payer COB [coordination of benefits with patient responsibility amount and a valid Other Coverage Code, (e.g. 8, 3)]. The patient’s out-of-pocket expense will be reduced up to the maximum savings limit for the program. Reimbursement will be received from Change Healthcare. Valid Other Coverage Code required.
  3. For any questions regarding Change Healthcare online processing, please call the Help Desk at 1-800-433-4893.