To the Patient:
You must present this coupon to the pharmacist along with your valid, signed prescription to receive this benefit. If you have any questions regarding your eligibility or benefits, call the Elestrin Savings Coupon program at 877-264-2440 (8:00 AM—8:00 PM ET, Monday—Friday). 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 of this offer.
If your pharmacy does not accept your Elestrin Savings Coupon, please follow the below steps in order to receive reimbursement (if eligible):
- Call 877-264-2440 and request to speak to an agent.
- Request a Direct Member Reimbursement (DMR) form, which will be mailed to you.
- Alternately, you can visit our website www.patientrebateonline.com and follow the instructions to print out your DMR form.
- Complete the form and return to the address on the form ,along with a copy of this coupon and your pharmacy receipt indicating your purchase of Elestrin including amount paid.
- If you are eligible, your benefit will be sent to you in the mail (this process typically takes 2-4 weeks).
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 commercially 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. You represent that use of this coupon is not inconsistent with your obligations as a network provider for any health plan and, as required, you will report acceptance of funds provided through this coupon to such plans. 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 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 the Elestrin Savings Coupon program at 877-264-2440 (8:00 AM—8:00 PM ET, Monday—Friday).
