![]() You have a valid 30-day prescription for ELIQUIS You have not previously filled a prescription for ELIQUIS You may be eligible for the Free 30-Day Trial offer for ELIQUIS® (apixaban) if: Please see Full Prescribing Information, including Boxed WARNINGS and Medication Guide. To the pharmacist: For processing assistance, please call McKesson Pharmacy Support at 1-86. For those customers using mail order or any non-participating retail pharmacy, please callĨ6 to request a patient rebate form, or go to to download a form.īY USING THIS CARD, YOU AND YOUR PHARMACIST UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE. The Co-pay Card will be accepted only at participating pharmacies. The Co-pay Card for ELIQUIS is not health insurance. This offer is not conditioned on any past, present, or future purchase, including refills. Reproductions of this Co-pay Card are void.īristol-Myers Squibb and Pfizer reserve the right to rescind, revoke, or amend this offer at any time without notice. The Co-pay Card may not be sold, purchased, traded, or counterfeited. This offer is non-transferable, no substitutions are permissible, and offer cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription. Only valid in the United States and Puerto Rico this offer is void where restricted or prohibited by law. ![]() Absent a change in Massachusetts law, for Massachusetts residents only, this offer will expire on January 1, 2021.Īll Program payments are for the benefit of the patient only. Upon expiration, eligible patients may re-enroll in the Co-pay Card Program. Activation and first use of the Co-pay Card must take place by December 31, 2021. Your acceptance of this offer confirms that this offer is consistent with your insurance and that you will report the value received as may be required by your insurance provider.Ĭard must be activated before use. 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. Offer not applicable to co-pays of $10 or less. Patient is responsible for applicable taxes, if any. ![]() You are a resident of the United States or Puerto Rico.Įligible patients who present an activated Co-pay Card together with a valid prescription for ELIQUIS at participating pharmacies may pay as little as $10 per 30-day supply (up to 74 tablets for the first fill and up to 60 tablets for all subsequent fills) for up to 24 months, subject to a maximum annual benefit of $3800. ![]() You do not have prescription insurance coverage through a state or federal healthcare program, including but not limited to Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), or Department of Defense (DOD) programs patients who move from commercial plans to state or federal healthcare programs will no longer be eligible You are insured by commercial insurance and your prescription insurance coverage does not cover the full cost of your prescription, that is, you have a co-pay obligation for ELIQUIS You may be eligible for the Co-pay Card for ELIQUIS® (apixaban) if:
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