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Eligibility & Terms of Use
ELIGIBILITY: You may be eligible for this offer if you are insured by commercial insurance and your insurance does not cover the full cost of your prescription, or you are not insured and are responsible for the cost of your prescriptions. Patients who are enrolled in a state or federally funded prescription insurance program are not eligible for this offer. This includes patients enrolled in Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DOD) programs or TriCare, and patients who are Medicare eligible and enrolled in an employer-sponsored group waiver health plan or government-subsidized prescription drug benefit program for retirees. If you are enrolled in a state or federally funded prescription insurance program, you may not use this savings card even if you elect to be processed as an uninsured (cash-paying) patient. This offer is not insurance, is restricted to residents of the United States and Puerto Rico, and to patients over 18 years of age. If you use a mail-order pharmacy, please contact your pharmacy provider to confirm if this offer will be accepted.
TERMS OF USE: Eligible commercially insured/covered patients with no restrictions (step-edit, prior authorization, or NDC block) and with a valid prescription who present this savings card at participating pharmacies may pay as low as $0 for BYDUREON BCise® (exenatide extended-release) injectable suspension 2 mg per 28-day supply subject to a maximum savings of $300 per 28-day supply. Patient out-of-pocket expense may vary. If you pay cash for your prescription, or are insured and your insurance does not cover or has a managed care restriction on your prescription (step-edit, prior authorization, or NDC block), AstraZeneca will pay up to the first $150 for BYDUREON BCise and you will be responsible for any remaining balance, for each monthly prescription. Other restrictions may apply. Patient is responsible for applicable taxes, if any. Non-transferable, limited to one per person, cannot be combined with any other offer. Void where prohibited by law, taxed or restricted. 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. AstraZeneca reserves the right to rescind, revoke, or amend this offer, eligibility and terms of use at any time without notice. This offer is not conditioned on any past, present or future purchase, including refills. Offer must be presented along with a valid prescription at the time of purchase. If you have any questions regarding this offer, please call 1-866-680-9081.
BY USING THIS CARD, YOU AND YOUR PHARMACIST UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.
Pharmacist Instructions for a Patient with an Eligible Third Party:
For Insured/Covered Patients: Submit the claim to the primary Third-Party Payer first, then submit the balance due to CHANGE HEALTHCARE as a Secondary Payer COB with patient responsibility amount and a valid Other Coverage Code of 8. This will reduce the eligible patient’s out-of-pocket costs to as low as $0 per 28-day supply for BYDUREON BCise® (exenatide extended-release) injectable suspension 2 mg subject to a maximum savings of $300 per 28-day supply. Patient out-of-pocket expenses may vary. Reimbursement will be received from CHANGE HEALTHCARE.
Pharmacist Instructions for Insured/Not Covered Patients: Submit the claim to the primary Third-Party Payer first. If the primary claim submission shows a managed care restriction (step-edit, prior authorization, or NDC block), continue the claim adjudication process and submit the balance due to CHANGE HEALTHCARE as a Secondary Payer COB with patient responsibility amount and a valid Other Coverage Code of 3. This will reduce eligible patient’s out-of-pocket costs by $150 per 28-day supply for BYDUREON BCise. Reimbursement will be received from CHANGE HEALTHCARE.
Pharmacist Instructions for a Cash-Paying Patient: Submit this claim to CHANGE HEALTHCARE. A valid Other Coverage Code (eg, 1) is required. The card will cover up to $150 per 28-day supply for BYDUREON BCise. Reimbursement will be received from CHANGE HEALTHCARE. Valid Other Coverage Code Required. For any questions regarding CHANGE HEALTHCARE online processing, please call the Help Desk at 1-800-422-5604.
US-50877 Last Updated 3/21
Call your mail-order pharmacy to see if they accept the BYDUREON BCise Savings Card:
- If yes, give them your BYDUREON BCise Savings Card number after they receive your prescription
- You will receive your rebate when the pharmacy processes your prescription
If your mail-order pharmacy does NOT accept the BYDUREON BCise Savings Card:
- Click here to download a patient request form, or call 1-855-292-5986
- When you have your form, complete and sign it
- Next, staple the original mail-order receipt onto your form and return both to the address listed
- You should receive a rebate check in 3 to 4 weeks - be sure to keep a copy of your receipts for your records
- Every monthly refill requires a new request form - complete the same steps as above to receive your rebate
Are you eligible? Check out your Terms and Conditions
Supporting your BYDUREON BCise experience:
IMPORTANT SAFETY INFORMATION
BYDUREON BCise may cause serious side effects, including:
- POSSIBLE THYROID TUMORS, INCLUDING CANCER Tell your healthcare provider if you get a lump or swelling in your neck, hoarseness, trouble swallowing, or shortness of breath. These may be symptoms of thyroid cancer. In animal studies, BYDUREON and medicines that work like it caused thyroid tumors, including thyroid cancer. It is not known if BYDUREON BCise will cause thyroid tumors or a type of thyroid cancer called medullary thyroid carcinoma (MTC) in people
- Do not use BYDUREON BCise if you or any of your family members have ever had MTC or if you have an endocrine system condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
- Do not use BYDUREON BCise if you have a history of low blood platelet count from using exenatide medicines (drug-induced thrombocytopenia)
- Do not use BYDUREON BCise if you have had an allergic reaction to exenatide or any of the other ingredients in BYDUREON BCise
- Inflammation of the pancreas (pancreatitis) Stop using BYDUREON BCise and call your healthcare provider right away if you have severe pain in your stomach area (abdomen) that will not go away, with or without vomiting. You may feel the pain from your abdomen to your back
- Low blood sugar (hypoglycemia) Your risk for getting low blood sugar may be higher if you use BYDUREON BCise with another medicine that can cause low blood sugar, such as a sulfonylurea or insulin. Tell your healthcare provider if you take other diabetes medicines. Talk to your healthcare provider about managing low blood sugar. Signs and symptoms of low blood sugar include dizziness or lightheadedness, sweating, confusion or drowsiness, headache, blurred vision, slurred speech, shakiness, fast heartbeat, anxiety, irritability, mood changes, hunger, weakness, or feeling jittery
- Kidney problems Tell your healthcare provider if you have or had kidney problems. In people who have kidney problems, diarrhea, nausea, and vomiting may cause a loss of fluids (dehydration), which may cause kidney problems to get worse or kidney failure
- Stomach problems Tell your healthcare provider if you have severe stomach problems, such as slowed emptying of your stomach (gastroparesis) or problems digesting food. Other medicines like BYDUREON BCise may cause severe stomach problems. It is not known if BYDUREON BCise causes or worsens stomach problems
- Low blood platelet count BYDUREON BCise may cause the number of platelets in your blood to be reduced. When your platelet count is too low, your body cannot form blood clots. You could have serious bleeding that could lead to death. Stop using BYDUREON BCise and call your healthcare provider right away if you have unusual bleeding or bruising
- Serious allergic reactions Stop using BYDUREON BCise and get medical help right away if you have any symptoms of a serious allergic reaction, including itching, rash, or difficulty breathing
- Injection-site reactions Serious injection-site reactions, with or without bumps (nodules), have happened in some people who use BYDUREON BCise. Some of these injection-site reactions have required surgery. Call your healthcare provider if you have any symptoms of injection-site reactions, including severe pain, swelling, blisters, an open wound, or a dark scab
- Gallbladder problems have happened in some people who take BYDUREON or other medicines like it. Tell your healthcare provider right away if you get symptoms of gallbladder problems including pain in the right or middle upper stomach area, nausea and vomiting, fever, or your skin or the white part of your eyes turns yellow
The most common side effects with BYDUREON BCise may include a bump at the injection site and/or nausea. Nausea is most common when you first start using BYDUREON BCise, but decreases over time in most people as their body gets used to the medicine.
Tell your healthcare provider about all of the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements, as taking them with BYDUREON BCise may affect how each medicine works.
Before using BYDUREON BCise, tell your healthcare provider if you are pregnant, nursing, or plan to become pregnant or nurse. BYDUREON BCise may harm your unborn baby.
APPROVED USES
- BYDUREON BCise is an injectable prescription medicine that may improve blood sugar (glucose) in adults with type 2 diabetes mellitus, and should be used along with diet and exercise
- BYDUREON BCise is not recommended as the first choice of medicine for treating diabetes
- BYDUREON BCise is not for people with type 1 diabetes
- Do not use BYDUREON, BYDUREON BCise, BYETTA or other medicines containing exenatide together
- It is not known if BYDUREON BCise can be used in people with a history of pancreatitis
Approved Uses and Important Safety Information
POSSIBLE RISK OF THYROID TUMORS INCLUDING THYROID CANCER
Read More
For US Consumers
BYETTA, BYDUREON and BCise are registered trademarks, and AZ&Me is a trademark of the AstraZeneca group of companies. All other trademarks are property of their respective owners.
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US-50877; US-53778 Last Updated 5/21