Copay Savings Card

About the EMBEDA Copay Savings Card:
  • After paying an initial $25 out-of-pocket cost for their prescription, patients can receive up to $150 in savings.
  • Any total prescription cost over $100 will be added to the initial $25 copay.
  • Patients can use their card up to 12 times per calendar year and save up to $1800.
  • For assistance finding this product in a pharmacy near you, please call 1-800-682-7796.
  • Patients can activate their card by calling 1-800-937-4204 or by visiting
    www.EMBEDA.com.
Additional copay information
  • With the EMBEDA copay savings card, eligible commercial patients pay as little as $25 a month for up to 12 months.*
    At participating pharmacies, EMBEDA leverages eVoucherRx™ from RelayHealth to automatically apply the EMBEDA savings offer. Tier 3 and Tier 4 commercial patients will automatically have the savings card applied. Find participating pharmacies at www.eVoucherRx.RelayHealth.com/storelookup/.

*Eligibility required. Accepted only at participating pharmacies. Patients must agree to the Terms and Conditions below. There are no membership fees. This card is not health insurance.

TERMS AND CONDITIONS

By using this co-pay card, you acknowledge that you currently meet the eligibility criteria and will comply with the terms and conditions described below: 

  • Patients are not eligible to use this card if they are enrolled in a state or federally funded insurance program, including but not limited to Medicare, Medicaid, TRICARE, Veteran Affairs health care, a state prescription drug assistance program, or the Government Health Insurance Plan available in Puerto Rico (formerly known as “La Reforma de Salud”). 
  • Patient must have private insurance. Offer is not valid for cash paying patients. The value of this co-pay card is limited to $25 per use or the amount of your co-pay, whichever is less. 
  • This co-pay card is not valid when the entire cost of your prescription drug is eligible to be reimbursed by your private insurance plan or other private health or pharmacy benefit programs. 
  • You must deduct the value of this co-pay card from any reimbursement request submitted to your private insurance plan, either directly by you or on your behalf. 
  • You are responsible for reporting use of the co-pay card to any private insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the co-pay card, as may be required. You should not use the co-pay card if your insurer or health plan prohibits use of manufacturer co-pay cards. 
  • You must be 18 years of age or older to redeem the co-pay card. 
  • This co-pay card is not valid for Massachusetts residents whose prescriptions are covered in whole or in part by third-party insurance.
  • This co-pay card is not valid for California residents whose prescriptions are covered in whole or in part by third-party insurance. 
  • This co-pay card is not valid where prohibited by law. 
  • Co-pay card cannot be combined with any other savings, free trial or similar offer for the specified prescription.
  • Co-pay card will be accepted only at participating pharmacies. 
  • If your pharmacy does not participate, you may be able to submit a request for a rebate in connection with this offer. 
  • This co-pay card is not health insurance. 
  • Offer good only in the U.S. and Puerto Rico. 
  • Co-pay card is limited to 1 per person during this offering period and is not transferable. 
  • A co-pay card may not be redeemed more than once per 30 days per patient.  
  • No other purchase is necessary. 
  • Data related to your redemption of the co-pay card may be collected, analyzed, and shared with Pfizer, for market research and other purposes related to assessing Pfizer’s programs. Data shared with Pfizer will be aggregated and de-identified; it will be combined with data related to other co-pay card redemptions and will not identify you. 
  • Pfizer reserves the right to rescind, revoke or amend this offer without notice. 
  • Offer expires 12/31/2019. 

For reimbursement when using a non-participating pharmacy/mail order: Pay for the prescription and mail the following:

  1. Copy of card OR original card
  2. Original pharmacy receipt OR a copy of the receipt which shows your name, the pharmacy name, the name of the medication, the price you paid, and the date it was purchased (cash register receipt not valid)
  3. Patient name, mailing address and signature
EMBEDA PALA $25 Copay Card Program
2250 Perimeter Park Drive, Suite 300 
Morrisville, NC 27560


I agree to the terms and conditions received with this Card.

Pfizer Inc
235 E 42nd Street
New York, NY 10017

www.pfizer.com

1-800-937-4204