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 $75 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 $900.
  • 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 Copay Savings Card, you acknowledge that you currently meet the eligibility criteria and will comply with the following terms and conditions: This Card is not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare, Tricare or other federal or state healthcare programs (including any state prescription drug assistance programs) and the Government Health Insurance Plan available in Puerto Rico (formerly known as “La Reforma de Salud”). Use of this Card will allow the consumer to pay as little as $25 out-of-pocket per prescription. This Card is limited to $25 or the amount of your copay, whichever is less, per prescription. Any total prescription cost over $100 will be added to the initial $25 copay. Depending on an individual’s copay, savings may be up to $75 per prescription. This Card is not valid when the entire cost of your prescription drug is eligible to be reimbursed by your private insurance plans or other health or pharmacy benefit programs. You must deduct the value of this Card from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf. This Card is not valid where prohibited by law. Cannot be combined with any other rebate/coupon, free trial or similar offer for the specified prescription. This Card will be accepted only at participating pharmacies. This Card is not health insurance. Offer good only in the U.S. and Puerto Rico. Use of this Card is limited to 1 per person during this offering period and is not transferable. This Card may not be redeemed more than once per month per patient. Pfizer reserves the right to rescind, revoke or amend this offer without notice. Offer expires 12/31/18.

For reimbursement when using a non-participating pharmacy/mail order: Pay for the prescription, and mail copy of original pharmacy receipt (cash register receipt NOT valid) with product name, date, and amount circled to:

Copay Savings Card
2250 Perimeter Park Drive, Suite 300
Morrisville, NC 27560

Be sure to include your name, mailing address, and a photocopy of the front of your copay card.

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