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PULMICORT FLEXHALER Savings Card

PULMICORT FLEXHALER has broad formulary coverage
and an offer for only $20 a month*

PULMICORT FLEXHALER is covered for over 80% of patients nationwide.1

Help your eligible patients save on monthly out-of-pocket costs for PULMICORT FLEXHALER.

“Coverage” means covered lives (Commercial, Commercial [BCBS], Employer, Municipal Plan, PBM, Union) at Tiers 1-7 in the US, calculated by Fingertip Formulary® as of October 9, 2015.

“Patients” means covered lives for all plan types (Commercial, Commercial [BCBS], Commercial [Medicaid], Discount Prescription Programs, Employer, Medicare MA, Medicare PDP, Medicare SN, Municipal Plan, PBM, State Medicaid, Union) nationwide calculated by Fingertip Formulary® as of October 9, 2015.

  • Eligible commercially insured patients will pay no more than $20 per month for up to a year with the PULMICORT FLEXHALER Savings Card.
  • Eligible patients can save up to $50 on out-of-pocket costs exceeding $20 for each refill for up to 12 refills.*

*Subject to eligibility rules; restrictions apply. See details below.


Please click here for full Prescribing Information for PULMICORT FLEXHALER.

ELIGIBILITY: You may be eligible for this offer if you are insured by commercial insurance and your insurance does not cover the full cost of your prescription, or you are not insured and are responsible for the cost of your prescriptions.

Patients who are enrolled in a state or federally funded prescription insurance program are not eligible for this offer. This includes patients enrolled in Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), 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-subsidized prescription drug benefit program for retirees.

If you are enrolled in a state or federally funded prescription insurance program, you may not use this Savings Card even if you elect to be processed as an uninsured (cash-paying) patient.

This offer is not insurance and is restricted to residents of the United States and Puerto Rico and patients over 6 years of age. This offer is valid for retail prescriptions only.

TERMS OF USE: Eligible commercially insured patients with a valid prescription for PULMICORT FLEXHALER® (budesonide inhalation powder) inhaler who present this Savings Card at participating pharmacies will pay $20 per 30-day supply, subject to a maximum savings of $50 per 30-day supply. Cash-paying patients will receive up to $50 in savings on out-of-pocket costs per 30-day supply. This offer is good for 12 uses, and each 30-day supply counts as 1 (one) use. Other restrictions may apply. Offer expires 12/31/16. Patient is responsible for applicable taxes, if any. If you have any questions regarding this offer, please call
1-800-422-5604.

Non-transferable, limited to one per person, cannot be combined with any other offer. Void where prohibited by law, taxed, or restricted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer. AstraZeneca reserves the right to rescind, revoke, or amend this offer, eligibility, and terms of use at any time without notice. This offer is not conditioned on any past, present, or future purchase, including refills. Offer must be presented along with a valid prescription for PULMICORT FLEXHALER at the time of purchase. If your commercial Insurance plan does not cover PULMICORT FLEXHALER, use of this offer permits your health care provider or pharmacy to share limited information with certain AstraZeneca vendors to determine if additional resources may be available to you; and to act on your behalf to initiate any processes that may be necessary to access these resources.

BY USING THIS CARD, YOU AND YOUR PHARMACIST UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

Pharmacist instructions for a patient with an eligible Third Party: Submit the claim to the primary Third-Party Payer first, then submit the balance due to Therapy First Plus as a Secondary Payer COB [coordination of benefits] with patient responsibility amount and a valid Other Coverage Code, (eg, 8). The patient is responsible for the first $20 and the card will cover up to $50 of their copay and reimbursement will be received from Therapy First Plus.

Pharmacist instructions for a cash-paying patient: Submit this claim to Therapy First Plus. A valid Other Coverage Code (eg, 1) is required.The patient is responsible for the first $20 and the card will cover up to the next $50 and you will receive this in your reimbursement from Therapy First Plus.

Valid Other Coverage Code required: For any questions regarding Therapy First Plus online processing, please call the Help Desk at 1-800-422-5604.

Program managed by PSKW, LLC, on behalf of AstraZeneca.

Card expires on 12/31/2016.

NEXT:PULMICORT FLEXHALER SAMPLES

Reference:

1. Fingertip Formulary.® 10/09/2015.

IMPORTANT SAFETY INFORMATION AND INDICATION

  • PULMICORT FLEXHALER is not a bronchodilator and is NOT indicated for the relief of acute bronchospasm.
  • Particular care is needed for patients who are transferred from systemically active corticosteroids to PULMICORT FLEXHALER because deaths due to adrenal insufficiency have occurred in asthmatic patients during and after transfer from systemic corticosteroids to less systemically available inhaled corticosteroids.
  • Due to possible immunosuppression, potential worsening of infections could occur. A more serious or even fatal course of chickenpox or measles can occur in susceptible patients.
  • It is possible that systemic corticosteroid effects such as hypercorticism, reduced bone mineral density, and adrenal suppression may appear in a small number of patients, particularly at higher doses.
  • Inhaled corticosteroids may cause a reduction in growth velocity. The long-term effect on final adult height is unknown.
  • Rare instances of glaucoma, increased intraocular pressure, and cataracts have been reported following the inhaled administration of corticosteroids.
  • Hypersensitivity reactions, including anaphylaxis, have been reported with budesonide.
  • PULMICORT FLEXHALER contains small amounts of lactose, which contains trace levels of milk proteins. In patients who have severe milk protein allergy (not those who are lactose intolerant) cough, wheezing, or bronchospasm may occur.
  • Adverse reactions that occurred at a rate of ≥ 1% are: nasopharyngitis, nasal congestion, pharyngitis, allergic rhinitis, viral upper respiratory tract infection, nausea, viral gastroenteritis, otitis media, and oral candidiasis.

INDICATION

  • PULMICORT FLEXHALER is indicated for the maintenance treatment of asthma as prophylactic therapy in adult and pediatric patients 6 years of age or older.

Please click here for full Prescribing Information for PULMICORT FLEXHALER.

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.