YOUR ACTIVATION WAS A SUCCESS
CONGRATULATIONS! YOUR 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.
OFFER TERMS AND CONDITIONS:
By using the Co-Pay Savings Card, you acknowledge that you currently meet the eligibility criteria and will comply with the following terms and conditions:
This offer is not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare, Tricare, 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”). Savings are limited to $140 per month per prescription or the amount of your co-pay, whichever is less. (Maximum annual savings of $1680.) This offer is not valid when the entire cost of your prescription drug is eligible to be reimbursed by your private insurance plans or other health or pharmacy benefit programs. 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. You must be 18 years of age or older to accept this offer. This offer is not valid where prohibited by law. This offer cannot be combined with any other rebate/coupon, free trial or similar offer for the specified prescription. The co-pay card will be accepted only at participating pharmacies. The co-pay card is not health insurance. Offer valid only in the U.S. and Puerto Rico. The co-pay card is limited to one per person during this offering period and is not transferable. Pfizer reserves the right to rescind, revoke or amend this offer without notice. No membership fee. Offer expires 12/31/2018.
For reimbursement when using a nonparticipating pharmacy/mail order:
Pay for prescription, and mail copy of original pharmacy receipt (cash register receipt NOT valid) with product name, date, and amount circled to: Co-Pay Savings Card, 2250 Perimeter Park Drive, Suite 300, Morrisville, NC 27560. Be sure to include a copy of the front of your activated Co-Pay Savings Card, your name and mailing address.