To the Patient:
You must present this coupon to the pharmacist along with your prescription to participate in this program. If you have any questions regarding your eligibility or benefits, or if you wish to discontinue your participation, call the Elestrin Savings Coupon program at 877-264-2440 (8:00 AM-8:00 PM EST, Monday-Friday). When you use this coupon, you are certifying that you understand the program rules, regulations, and terms and conditions. You are not eligible if prescriptions are paid by any state or other federally funded programs, including, but not limited to Medicare or Medicaid, Medigap, VA or DOD or TriCare, or where prohibited by law; and you will otherwise comply with the terms above. This offer is for eligible patients only and limited to 12 benefits per year and a maximum savings of $35 per prescription for NDC: 18860-0480-60 (52 gram dual pack) and a maximum savings of $15 per prescription for NDC: 18860-0480-01 (26 gram container).
To the Pharmacist:
When you use this coupon, you are certifying that you have not submitted and will not submit a claim for reimbursement under any federal, state or other governmental programs for this prescription.
- Submit transaction to McKesson Corporation using BIN #610524.
- This offer is not limited to insured patients; cash payers are also eligible to receive coupon savings.
- If primary coverage exists, input card information as secondary coverage and transmit using the COB segment of the NCPDP transaction. Applicable discounts will be displayed in the transaction response.
- Acceptance of this coupon and your submission of claims for the Elestrin Savings Coupon program are subject to the LoyaltyScript® program Terms and Conditions posted at http://www.mckesson.com/mprstnc
- Patient is not eligible if prescriptions are paid in part or full by any state or federally funded programs, including but not limited to Medicare or Medicaid, Medigap, VA, DOD or TriCare and where prohibited by law.
- For questions regarding setup, claim transmission, patient eligibility or other issues, call the LoyaltyScript® for Elestrin Savings Coupon program at 877-264-2440 (8:00 AM-8:00 PM EST, Monday-Friday).
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RxBIN: 610524 |
Distributed by: Jazz Pharmaceuticals |
© 2012 Jazz Pharmaceuticals®
Indication
Elestrin is indicated for the treatment of moderate-to-severe hot flashes and night sweats associated with menopause.
Important Safety Information
Estrogens, with or without progestins, should not be used for the prevention of cardiovascular disease or dementia (decline in memory or thinking skills). Estrogen and progestin therapy has shown an increased risk of breast cancer, heart attack, and blood clots. Estrogen therapy, with or without progestins, increases the risk of stroke and dementia. Estrogen therapy alone increases the risk of cancer of the uterus (womb).
Elestrin should not be used if you have unusual vaginal bleeding; currently have or have had certain cancers, including cancer of the breast or uterus; had a stroke or heart attack in the recent past; currently have or have had blood clots; currently have or have had liver problems; or think you may be or know that you are pregnant.
The most frequently reported adverse events in clinical trials were nose and throat irritation, breast tenderness, upper respiratory tract infection, and irregular menstrual bleeding.
You and your healthcare provider should discuss whether Elestrin is right for you or whether you still need treatment with Elestrin.
Estrogens, with or without progestins, should be prescribed at the lowest effective doses and for the shortest duration consistent with treatment goals and risks for the individual woman.
Please see full Prescribing Information, including Boxed Warning and Patient Information Sheet.
You are encouraged to report negative side effects of prescription drugs to the FDA (Food and Drug Administration).
Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
For more information, call 1-800-890-3098.