PAY AS LITTLE AS $20* FOR EACH PULMICORT FLEXHALER PRESCRIPTION WITH THE AZHELPS SAVINGS CARD.
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*Subject to eligibility rules; restrictions apply.
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.
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 12/31/18. Patient is responsible for applicable taxes, if any. If you have any questions regarding this offer, please call 1-800-236-9933.
Pharmacist for a Patient With an Authorized 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 as a copay-only billing using a valid Other Coverage Code (eg, 8). For the patient’s first through twelfth uses, the patient is responsible for the first $20 and the card pays up to the next $50. Reimbursement will be received from Therapy First Plus.
Pharmacist for a cash-paying patient: Submit this claim to Therapy First Plus. A valid Other Coverage Code (eg, 1) is required. For the patient’s first through twelfth uses the patient is responsible for the first $20 and the card pays up to the next $50. Reimbursement will be received 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 P.S.K.W. & Associates on behalf of AstraZeneca. Product dispensed pursuant to program rules, and federal and state laws. This offer may be changed or discontinued at any time without notice.
Card expires on 12/31/2018.