# You are now Opted Out of your $0 copay

## Prescription Program with Aphora Health

Feel free to come back to Opt In at any time!

**Yes, I Want to Take Advantage of This Program**
- Yes, I want **$0 copay** for my medications covered in the program
- Yes, I want to **receive up to $500** for qualifying specialty medications
- Yes, I want a personalized pharmacy experience designed around me
- Yes, I want support from a real person to manage my prescriptions

Activation takes just a few minutes, or **our team can do it for you**.

## Before You Go

### Would you mind telling us why you Opted Out?
- I'm satisfied with how much I pay with my current pharmacy
- I don't like change
- I am not interested in $0 copay
- I didn't quite understand the sign up process

If none of these boxes apply, please answer in your own words:  
**Your Name**  
**Your Email Address**

Thank you! Your submission has been received!

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