SEEBRI® NEOHALER® Savings
There are three ways to save on your SEEBRI NEOHALER prescription.
eVoucherRx is a paperless electronic coupon program that makes co-pay savings on your prescription for SEEBRI NEOHALER easy for you, your physician, and your pharmacist. Simply take your eligible prescription for SEEBRI NEOHALER to a participating pharmacy and the eVoucherRx savings coupon will be automatically applied to your co-pay so you may pay as little as $10.† For participating pharmacy locations, visit www.evoucherrx.relayhealth.com/storelookup.
If your pharmacy doesn't qualify for this savings, a co-pay savings card is available. See below for more information.
†Restrictions apply. Offer valid only for those with commercial insurance. This offer is not valid under Medicare, Medicaid, or any other federal or state program. Please see Savings Terms and Conditions. eVoucherRx™ is a trademark of RelayHealth and/or one of its subsidiaries.
The SEEBRI NEOHALER Savings Card and 30-day Free Trial Voucher
Sign up to see if you're eligible for the SEEBRI NEOHALER Savings Card and your out-of-pocket SEEBRI NEOHALER cost may be as little as a $10 co-pay. You may also qualify for a 30-day trial offer.*
*Restrictions and eligibility requirements apply. SEEBRI NEOHALER Savings Terms & Conditions.
Savings Terms and Conditions
By using this program, you acknowledge that you currently meet the following eligibility requirements:
You must be 18 years of age or older to accept this offer. This offer is valid only for eligible patients and legal guardians of eligible patients. Patients must have a valid prescription for SEEBRI NEOHALER within SEEBRI NEOHALER approved indication. Offer not valid if prescription is paid in part or full by any state or federally funded health care program, including but not limited to Medicare, Medicaid, VA, DoD or TRICARE, or where prohibited by law.
This program is valid for up to $250 off each prescription fill for up to a 30-day supply. The program is further limited to twelve (12) qualifying prescription fills. Offer is limited to one per person and may not be used with any other offer. This program is not health insurance. The amount of the benefit cannot exceed the patient's out-of-pocket expenses.
Acceptance of this offer must be consistent with the terms of any drug benefit provided by a health insurer, health plan, or other third-party payer. If requested or required by any such payer, the patient must report the use of this program. The patient must deduct the value of the savings received under this program from any reimbursement request submitted to the patient's insurance plan, either directly or on the patient's behalf.
For California and Massachusetts residents, benefits pursuant to this program will terminate automatically upon the introduction of a therapeutically equivalent product. Offer valid only in the United States and Puerto Rico. Void where prohibited by law, taxed or restricted. Sunovion reserves the right to rescind, revoke or amend this offer at any time without notice. This offer is not transferable and may not be sold, purchased, or traded, or offered for sale, purchase, or trade.
To the Patient: You must present this card, if applicable, to the pharmacist along with your prescription to participate in this program. If you have any questions regarding your eligibility or benefits, or if you wish to discontinue your participation, call the SEEBRI NEOHALER Savings Program at 1-844-276-8262 8:00AM–8:00PM (EST), Monday through Friday. By using this program, you are certifying that you understand the enclosed program rules, regulations, and terms and conditions; you have not submitted and will not submit a claim for reimbursement under any federal, state, or other governmental program for this prescription or where otherwise prohibited by law in your state; and you will otherwise comply with the terms mentioned herein.
To the Pharmacist: When you use this program, you are certifying that you have not submitted and will not submit a claim for reimbursement under any federal, state, or other governmental program for this prescription. If benefit does not apply automatically, submit transaction to McKesson Corporation using BIN# 610524. If primary commercial prescription insurance exists, input program information as secondary coverage and transmit using the COB segment of the NCPDP transaction. Applicable discounts will be displayed in the transaction response. Acceptance of this program and your submission of claims for the program are subject to the LoyaltyScript® program Terms and Conditions posted at www.mckesson.com/mprstnc. Patient is not eligible if prescriptions are paid in part or full by any state or federally funded health care program, including but not limited to Medicare or Medicaid, VA, DoD or TRICARE, or where prohibited by law. For questions regarding setup, claim transmission, patient eligibility, or other issues, call the LoyaltyScript® Savings Program at 1-844-276-8262, 8:00AM–8:00PM (EST), Monday through Friday.
Free Trial Offer Terms and Conditions
No purchase required. This free trial is not health insurance. Void where prohibited by law. Product dispensed pursuant to Terms and Conditions of voucher. Claim shall not be submitted to any public or private third-party payer or any federal or state health care program for reimbursement. Submit claim to McKesson Corporation. Valid only in the US and Puerto Rico. Offer not valid if reproduced or submitted to any other payer. It is illegal for any person to sell, purchase or trade, or offer to sell, purchase or trade, or to counterfeit, this voucher. Prescriber ID# required on prescription. Sunovion Pharmaceuticals Inc. reserves the right to rescind, revoke, or amend this offer at any time. This offer will expire on [03/31/2020].
TrialScript® is a registered trademark of McKesson Corporation.