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BYDUREON Savings Card

The BYDUREON Savings Card can help you pay as little as $25 a month for your BYDUREON Prescription TODAY.*

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*Subject to eligibility. Restrictions apply. See below for details.

If eligible, show your card and prescription to your pharmacist for instant savings.

*Patient Eligibility for Savings Card: 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 and is restricted to residents of the United States and Puerto Rico. You must be 18 years of age or older.

Terms of Use: Eligible patients with a valid prescription for BYDUREON® (exenatide extended-release) for injectable suspension who present an activated Savings Card at participating pharmacies may be able to pay no more than [$25] per 28-day supply for up to 24 months, subject to a maximum savings of [$100] per 28-day supply. Offer not applicable to out-of-pocket expenses of [$25] or less. Offer valid for up to a total of 26 refills, within 24 months, as prescribed. Every year thereafter, patients will be required to renew eligibility.

Card must be activated before use. This offer will expire on [December 31, 2016].

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 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 for BYDUREON at the time of purchase. If you have any questions regarding this offer, please call 1-877-700-7365.

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: Submit the claim to the primary Third-Party Payer first, then submit the balance due to Therapy First Plus as a Secondary Payer COB with patient responsibility amount and a valid Other Coverage Code (eg, 8). The patient is responsible for the first $18 on a 30-day supply, $36 on 60-day supply, or $54 on 90-day supply and the card will cover up to $50 per 30-day supply. Reimbursement will be received from Therapy First Plus.

Pharmacist Instructions for a Cash-paying Patient: Submit this claim to Therapy First Plus. A valid Other Coverage Code (eg, 1) is required. The card will cover up to $50 per 30-day supply. Reimbursement will be received from Therapy First Plus.

Valid Other Coverage Code Required: For any questions regarding Therapy First Plus online processing, please call the Help Desk at 1-800-422-5604.

Program managed by PSKW, LLC, on behalf of AstraZeneca.

*Eligibility requirements and terms of use apply.

Even with insurance, the monthly out-of-pocket costs for your medicine can really add up. We want to help. Eligible patients can pay as little as $25 a month for BYDUREON with a BYDUREON Savings Card.

Your savings will continue for as long as your doctor prescribes BYDUREON (within a 24-month period) and you remain eligible. Your card even saves you money when you fill your prescription through a mail-order pharmacy.

Get started in 3 simple steps:

  1. Have a valid new prescription for BYDUREON Single-dose Tray or BYDUREON Pen.

  2. Call 1-855-292-5968 to request or activate your BYDUREON Savings Card.

  3. Retail customers: Present the card with your prescription to the pharmacist.
    Mail-order customers: Call the number on the card and ask for Customer Service. See detailed instructions below.

We’re working to reduce your out-of-pocket prescription costs. So take advantage of the BYDUREON Savings Card today. If you have any questions about the BYDUREON Savings Card, call 1-855-292-5968.

BYDUREON Savings Card If you received a BYDUREON Savings Card from your doctor, get more information here.

ELIGIBILITY REQUIREMENTS, TERMS OF USE, AND MAIL-ORDER INSTRUCTIONS

ELIGIBILITY REQUIREMENTS

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 and is restricted to residents of the United States and Puerto Rico. You must be 18 years of age or older.

TERMS OF USE

  • Eligible patients with a valid prescription for BYDUREON® (exenatide extended-release) for injectable suspension who present an activated Savings Card at participating pharmacies may be able to pay no more than [$25] per 28-day supply for up to 24 months, subject to a maximum savings of [$100] per 28-day supply. Offer not applicable to out-of-pocket expenses of [$25] or less. Offer valid for up to a total of 26 refills, within 24 months, as prescribed. Every year thereafter, patients will be required to renew eligibility.

  • Card must be activated before use. This offer will expire on [December 31, 2016].

  • 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 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 for BYDUREON at the time of purchase. If you have any questions regarding this offer, please call 1-877-700-7365 .

BY USING THIS CARD, YOU AND YOUR PHARMACIST UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

MAIL-ORDER INSTRUCTIONS

If you use a mail-order pharmacy (or if your pharmacy does not accept the BYDUREON Savings Card), then follow the steps below:

  1. Call your mail-order pharmacy to see if they accept the BYDUREON Savings Card. If they do, provide them with your BYDUREON Savings Card number after they receive your prescription. You will receive your rebate when the pharmacy processes your prescription payment.

  2. If your mail-order or retail pharmacy does NOT accept the BYDUREON Savings Card:

    1. Call 1-855-292-5968 to request a patient rebate form, or go to www.patientrebateonline.com to download a form.

    2. When you receive your form, complete and sign it. Next, attach the original mail-order receipt and return it to the address listed on the form.

    3. Remember to keep a copy of your receipts for your records. You should receive your rebate check in 3 to 4 weeks.

  3. You will need to request/download a form each time you get a refill of your prescription and complete steps 2a and 2b to receive your rebate.

BYDUREON is ON IT when you need it – all week long.

Learn how BYDUREON works