Terms and Conditions

To participate in the Savings Program for XACIATO™ (clindamycin phosphate) vaginal gel 2% (“Program”), you must present this card, along with a valid prescription for XACIATO, to your pharmacist. Patients with commercial health insurance who qualify to participate may pay as little as $25 per prescription, subject to the Terms and Conditions, stated below. If you have any questions regarding eligibility, the Terms and Conditions, or to discontinue participation, please call 1-877-264-2440 (8:00 AM-8:00 PM EST, Monday-Friday).

• Savings card is only valid for commercially insured patients 12 years of age or older who may pay as little as $25. Patients under the age of 18 years will require consent from a parent or guardian . Offer applies to out-of-pocket expenses (co-pay) greater than $25, up to a maximum of $300 per calendar year. After the maximum benefit, the patient will be responsible for the remaining monthly out-of-pocket costs.
• This savings card is not valid for cash-paying patients.
• This offer is not valid for prescriptions paid in part or in full by any federally or state-funded insurance program, including but not limited to Medicaid, Medicare, Veterans Affairs healthcare, Department of Defense, or TRICARE.
• This savings program cannot be combined with any other coupon, cash discount card, certificate, voucher, or similar offer.
• The savings card may be redeemed only once every 21 days.
• This savings card is not valid where the entire cost of the patient’s prescription is eligible to be reimbursed by a commercial insurance plan or other commercial health or pharmacy benefit program.
• The savings card is limited to 1 per person and is not transferable. No substitutions are permitted.
• The savings card is not insurance.
• You must be 18 years of age or older to redeem the savings card for yourself or a minor (other age restrictions may apply). Patient, guardian, pharmacist, and prescriber agree not to seek reimbursement for all or any part of the benefit received by the recipient through the offer. Patient or guardian is responsible for reporting receipt of savings card benefit to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the savings card, as may be required.
• The savings card can be used only by eligible residents of the United States at participating eligible retail or mail-order pharmacies in the United States.
• It is illegal to sell, purchase, trade, or counterfeit, or offer to sell, purchase, trade, or counterfeit the savings card. Void if reproduced.
• This savings card is not valid where prohibited by applicable laws, rules, or regulations. This savings card may not be available to patients in all states.
• Data related to your redemption of the savings card may be collected, analyzed, and shared with Organon and its affiliates and partners, for market research and other purposes related to assessing savings card programs. Data shared with Organon and its affiliates and partners will be aggregated and de-identified, meaning it will be combined with data related to other savings card redemptions and will not identify you.
• ORGANON RESERVES THE RIGHT TO RESCIND, REVOKE, OR AMEND THIS PROGRAM AT ANY TIME WITHOUT NOTICE.