You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.
TRELEGY ELLIPTA was developed in collaboration with INNOVIVA
Trademarks are owned by or licensed to the GSK group of companies.
ELIGIBILITY REQUIREMENTS
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; and 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 if an AB-rated generic drug is available for the product.
TERMS OF USE: Eligible commercially insured patients with a valid prescription for TRELEGY 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 1 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.
The Following Questions Require a Selection:
Please enter your First Name.
Please enter your Last Name.
Please select Birthday Month.
Please select Birthday Year.
Please enter your Address 1.
Please enter your E-mail Address.
Please re-enter your E-mail Address.
Please enter your City.
Please select your State.
Please enter your Zip Code.
*Subject to eligibility; restrictions apply. TRELEGY available by prescription only.
Present this coupon and, if applicable, your insurance card with your prescription for TRELEGY at any participating pharmacy.
Eligible commercially insured patients will pay $10 per 30-day supply of TRELEGY.
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 offer is valid for up to 12 uses, and each 30-day supply counts as 1 use.
In order to receive 12 uses, the first use must occur before 12/31/2018.
This coupon may not be used by government beneficiaries, including those eligible for or enrolled in Medicare. For coupon eligibility purposes, Medicare-eligible patients include all those age 65 or older (see complete eligibility rules below).
This coupon is nontransferable. Duplicates of this uniquely coded coupon are invalid and not redeemable at the pharmacy.
This coupon is not health insurance.
If you use a mail-order pharmacy, please contact your pharmacy provider to ensure this offer will be accepted.
For pharmacy processing assistance or questions, please call the Help Desk at 1-866-747-1170.
HOURS OF OPERATION:
Monday–Friday 8:00 AM – 9:00 PM ET, Saturday 9:30 AM – 6:00 PM ET, excluding holidays
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.
To Healthcare Professional: If you are a healthcare professional who resides outside the state of Vermont but regularly practices in Vermont, please do not download, print, or otherwise accept coupons or vouchers for GSK products. Please visit www.GSKforyou.com for details.
Make sure to save this offer for refills
To get your offer sent to you for later use, please
enter your e-mail address below. By clicking submit, you are sending an e-mail containing your offer. The information you provide is not stored or used in
any way except to deliver this e-mail.
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 if an AB-rated generic drug is available for the product.
TERMS OF USE:
Eligible commercially insured patients with a valid prescription for TRELEGY 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 1 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.
PHARMACIST INSTRUCTIONS:
For Insured Patients: For reimbursement, submit the claim to the patient's primary third-party payer first, and then submit the balance due to McKesson.
For Cash-Paying Patients: For reimbursement, submit this claim to McKesson.
Reimbursement will be received from McKesson.
To the Pharmacist: BY REDEEMING THIS OFFER, I, the Pharmacist, UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS.
To the Patient: BY REDEEMING THIS OFFER, I, the Patient, UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.
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