Savings and support
for eligible patients

CoriumCares™ logo.

Eligible commercial
patients pay no more than
$30* per prescription

Corium is dedicated to providing eligible patients with copay
support to ensure access to ADLARITY®

ADLARITY® Copay Savings Card from CoriumCares™.

Confirm eligibility to access your copay card

*All fields are required unless otherwise noted. You must be 18 years or older
to complete this form.

To start, tell us a little bit
about the patient.

Is the patient covered by private or commercial insurance (not a government-funded insurance)?

Is the patient 18 years of age or older?

We're sorry, but based on your responses, you're not eligible for the ADLARITY Copay Savings Card. If you have additional questions, please call 1‑800‑910‑8432.

*Terms and Conditions: This offer is good for eligible commercially insured patients with a valid ADLARITY prescription and may not be used for any other product. Uninsured patients and cash-paying patients are not eligible. This offer is not insurance and is not valid for patients covered under Medicaid, Medicare, TRICARE, or any other federal or state healthcare program. This offer is not valid where prohibited by law, taxed, or restricted. This offer is valid regardless of choice of prescriber. This offer is not transferable and may not be combined with any other offer. This offer must be presented along with a valid prescription for ADLARITY at the time of purchase. This offer is only valid in the United States. Patient may not seek reimbursement for the value received from this program from other parties, including any health insurance program or plan, flexible spending account, or healthcare savings account. By using this offer, you are certifying that you meet the eligibility criteria and will comply with the Terms and Conditions. Corium, Inc. reserves the right to change or discontinue this offer at any time without notice. No other purchase is necessary. Questions and requests to discontinue participation in the program can be directed to 1‑800‑910‑8432 (8:00 am‑8:00 pm ET, Monday through Friday).