Pay no more than $10 a month on your prescription for TRELEGY for 12 months
Subject to eligibility. Restrictions may apply. This coupon may not be used by government beneficiaries, including those eligible for or enrolled in Medicare.
Eligible commercially insured patients will pay $10 per 30-day supply of TRELEGY.
Use of savings offer may be subject to meeting other plan requirements.
Eligible patients without insurance to cover the cost of their prescription will receive up to $100 in savings on each 30-day supply of TRELEGY. You will be responsible for any remaining out-of-pocket cost.
This is NOT health insurance.
Keep this coupon. It can be used once per month for up to 12 months prior to the expiration date. In order to receive 12 uses, the first use must occur before 1/31/2019. Each 30-day supply counts as 1 use.
Coupon should be presented to your pharmacist for each refill.
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ELIGIBILITY: Patients may be eligible for this offer if they have commercial insurance and insurance does not cover the full cost of the prescription or if they are not insured and are responsible for the cost of their prescriptions. Government beneficiaries; patients who are enrolled in any federal healthcare program, including patients enrolled in Medicare (Part D or otherwise), Medicaid, Medigap, Veterans Affairs (VA) or Department of Defense (DOD) programs, or TRICARE; patients who are Medicare eligible and enrolled in an employer-sponsored group waiver health plan or government prescription drug benefit program for retirees; or patients enrolled in any similar federal or state programs, including state pharmaceutical assistance programs, are NOT eligible for this offer. Further, patients CANNOT use this coupon if they are Medicare eligible. For coupon eligibility purposes, all those 65 or older will be considered Medicare eligible. If patients are government beneficiaries or Medicare eligible, they may not use this savings card even if they elect to be processed as an uninsured (cash-paying) patient. This offer is not health insurance and is restricted to residents of the United States, Puerto Rico, and US territories. Void where prohibited by law, taxed, or restricted. Not valid in Massachusetts or California if an AB-rated generic drug is available for the product.
TERMS OF USE: Eligible commercially insured patients with a valid prescription for TRELEGY (fluticasone furoate, umeclidinium, and vilanterol inhalation powder) who present this savings card at participating pharmacies will pay $10 per 30-day supply. Eligible patients without insurance will receive up to $100 in savings on each 30-day supply. This offer is valid for up to 12 uses, and each 30-day supply counts as one use. Patient is responsible for applicable taxes, if any. This offer is limited to one per person and is nontransferable and cannot be combined with any other coupon, free trial, or similar offer. No substitutions are permitted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the amount received by the patient through this offer. Offer must be presented along with a valid prescription for TRELEGY at the time of purchase. Your acceptance of this offer must be consistent with the terms of any drug benefit plan provided to you by your health insurer. You agree to report your use of this coupon to your health insurer if required.
GSK or McKesson (on GSK's behalf) reserves the right to rescind, revoke, or amend this offer at any time without notice. This offer may not be sold, purchased, traded, or counterfeited. Duplicates of this uniquely coded offer are invalid and not redeemable at the pharmacy. This offer is not conditioned on any past, present, or future purchase, including refills. This offer expires on 12/31/2019.
ELIGIBILITY REQUIREMENTS
ELIGIBILITY: Eligible patients presenting this offer along with a valid prescription for TRELEGY to their pharmacist will receive one free 30-day supply of TRELEGY. This offer can be used whether or not the patient has insurance for the amount of the out-of-pocket expense for the one 30-day prescription. This offer must be accompanied by a valid, signed prescription for TRELEGY. This offer MAY be used by patients who are eligible for or participate in federal healthcare programs such as Medicaid, Medicare (Part D or otherwise), or any similar federal or state programs, including any state pharmaceutical assistance program, PROVIDED this prescription will NOT be submitted for reimbursement to such government healthcare programs or to any private insurance, HMO, or other third-party payment arrangement; and it will NOT count towards out-of-pocket cost under a prescription drug plan, such as the "True Out-Of-Pocket (TrOOP)" expenses under Medicare Part D. This offer is not health insurance and is restricted to residents of the United States, Puerto Rico, and US territories. Void where prohibited by law, taxed, or restricted. Not valid in Massachusetts or California if an AB-rated generic drug is available for the product.
TERMS OF USE: Eligible patients who present a Free Trial Offer together with a valid 30-day prescription for TRELEGY at participating pharmacies can receive a free 30-day supply of TRELEGY. This Free Trial Offer may not be redeemed on prescriptions written for longer than 30 days. Patient is responsible for applicable taxes, if any. This offer is limited to one per patient and is nontransferable. The Free Trial Offer cannot be combined with any other coupon, free trial, or similar offer. No substitutions are permitted. Your acceptance of this offer must be consistent with the terms of any drug benefit plan provided to you by your health insurer. You agree to report your use of this coupon to your health insurer if required.
GSK or McKesson (on GSK's behalf) reserves the right to rescind, revoke, or amend this offer at any time without notice. This Free Trial Offer may not be sold, purchased, traded, or counterfeited. Duplicates of this uniquely coded Free Trial Offer are invalid and not redeemable at the pharmacy. This Free Trial Offer is not conditioned on any past, present, or future purchase, including refills. This offer will expire on 12/31/2018.
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