IMPORTANT SAFETY INFORMATION AND INDICATION
By using the Co-Pay Savings Card, you acknowledge that you currently meet the eligibility criteria and will comply with the following terms and conditions: This coupon 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”). Coupon is limited to $140 per month per prescription or the amount of your co-pay, whichever is less. (Maximum annual savings of $1680.) This coupon 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 coupon from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf. This coupon is not valid where prohibited by law. Coupon cannot be combined with any other rebate/coupon, free trial or similar offer for the specified prescription. Coupon will be accepted only at participating pharmacies. This coupon is not health insurance. Offer good only in the U.S. and Puerto Rico. Coupon is limited to 1 per person during this offering period and is not transferable. Pfizer reserves the right to rescind, revoke or amend this offer without notice. Offer expires 12/31/2018.
For reimbursement when using a non-participating pharmacy/mail order: Pay for prescription, and mail copy of original pharmacy receipt (cash register receipt NOT valid) with product name, date, and amount circled to: Co-Pay Savings Card, 2250 Perimeter Park Drive, Suite 300, Morrisville, NC 27560.
Be sure to include a copy of the front of your activated Co-Pay Savings Card, your name and mailing address.