YOUR ACTIVATION WAS A SUCCESS
CONGRATULATIONS! YOUR LYRICA CO-PAY
SAVINGS CARD IS NOW ACTIVATED*
USING YOUR ACTIVATED CARD IS EASY
Bring your activated Co-Pay Card and your LYRICA prescription to your pharmacy and present both when filling your prescription
Keep your card in your wallet and use it for up to 12 months
*Eligible patients save up to $140 a month for 12 months. (Maximum annual savings of $1680.) A rebate form is available for nonparticipating pharmacies. The savings card is not health insurance. No membership fees. See terms and conditions.
By using the LYRICA Co-Pay Savings Card, you acknowledge that you currently meet the eligibility criteria and will comply with the following terms and conditions: The Card is not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare (including Medicare Part D), or other federal or state healthcare programs (including any state prescription drug assistance programs and the Government Health Insurance Plan available in Puerto Rico [formerly known as “La Reforma de Salud”]). The Card is not valid for prescriptions that are eligible to be reimbursed by private indemnity or HMO insurance plans or other health or pharmacy benefit programs which reimburse you for the entire cost of your prescription drugs. Eligible patients will pay as little as $25 with a savings of up to $140 per prescription fill, for up to 12 offers per year. To qualify for this offer, the patient’s out-of-pocket expense must be a minimum of $25 per prescription. Depending on individual’s co-pay, savings may be up to $140 per prescription. You must deduct the value received under this program from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf. Cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription. The Card will be accepted only at participating pharmacies. This Card is not health insurance. Offer good only in the US and Puerto Rico. The Card is limited to 1 per person during this offering period and is not transferable. Pfizer reserves the right to rescind, revoke, or amend the program without notice. For expiration date, please refer to the Co-Pay Savings Card.
For reimbursement when using a non-participating pharmacy/mail order:
Pay for LYRICA prescription, and mail copy of original pharmacy receipt (cash register receipt NOT valid) with product name, date, and amount circled to: LYRICA Co-Pay Savings Card, 2250 Perimeter Park Drive, Suite 300, Morrisville, NC 27560.
Be sure to include a copy of the front of your Co-Pay Savings Card, your name and mailing address.