This Program is only valid for cost of the drug and not applicable to any related supplies or other medical expenses associated with administering the product
This Program is not conditioned on any past, present, or future purchase, including refills
Void where prohibited, taxed, or restricted by law
The patient confirms that this Program is consistent with patient’s insurance. The patient is responsible for reporting the receipt of all Program benefits as required by the insurance company
This Program is not insurance and is not intended to substitute for insurance
Limit 1 (one) Program ID number per patient
This ID number is non-transferable and has no value
Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer
