Frequently Asked Questions (FAQs) About the LIPITOR Savings Program*
|
|
- Katrina O’Connor’
- 6 years ago
- Views:
Transcription
1 Frequently Asked Questions (FAQs) About the LIPITOR Savings Program* *Terms and Conditions apply. Please see page 10 for details. You may pay less by receiving the generic. Below are some FAQs about the LIPITOR Savings Card that you may still have after visiting LIPITOR.com. Q: What is the LIPITOR Savings Card? A: The LIPITOR Savings Card allows certain eligible patients to get a 30-day supply of LIPITOR for $30. Other patients may be eligible to pay as little as $4 a month, depending on their insurance. It may work if you have insurance, are on Medicare Part D, or have no insurance at all, and is valid for every prescription or refill through December 31, Q: Do I need to activate my card? A: If you registered for your card online or by phone, it will come activated. If you received the card from your doctor, in the mail, or via , you will need to activate it. This only takes a few steps. To activate, visit LIPITOR.com or call the number on the front of the card. Q: How does the LIPITOR Savings Card work? A: 1. Once the card is activated, present it to your pharmacist when you drop off your prescription or request a refill. 2. During the payment process, the pharmacist will run your card, and your out-of-pocket cost will be either $30 or $4, depending upon your eligibility. 3. Visit LIPITOR.com to see how much you may pay. Q: What does the LIPITOR Savings Card cost? A: It is free to sign up and requires no membership fees. Please see full Prescribing and Patient Information for LIPITOR at LIPITOR.com. 1
2 Q: How long is my LIPITOR Savings Card valid? A: Once activated, your LIPITOR Savings Card is valid for every prescription or refill through December 31, Q: How is this card different from previous LIPITOR cards? A: The LIPITOR Savings Card provides more flexibility than previous LIPITOR cards by expanding insurance coverage, which helps more eligible patients get LIPITOR. Q: How do I get a replacement if I lose or damage my card? A: If your LIPITOR Savings Card gets lost or damaged, simply call us at , and we ll help you get a new one. Q: How can I have my name/ address removed so that I m not contacted again in the future? A: To remove your name from future LIPITOR communications, including refill reminders, please call the toll-free number, Eligibility Q: Who is eligible to use the LIPITOR Savings Card? A: This offer is for non-medicaid patients, aged 18 and older, living in the United States and Puerto Rico. This offer is not available to residents of Massachusetts, or to patients who have federal or state health insurance coverage, except for Medicare Part D. Medicare Part D patients may use the LIPITOR Savings Card, but cannot use their benefit in conjunction with the card. Q: Who may be eligible for the $4 co-pay for a 30-day supply of LIPITOR? A: You may be eligible for the $4 co-pay for a 30-day supply if: 1. You are a commercial patient using insurance that covers brand-name LIPITOR, and 2. Your out-of-pocket expense for a 30-day supply (30 tablets) is $130 or less. Please see full Prescribing and Patient Information for LIPITOR at LIPITOR.com. 2
3 Q: Who may be eligible for a $30 co-pay for a 30-day supply? A: You may be eligible for a $30 co-pay for a 30-day supply if: 1. You pay for brand-name LIPITOR without use of health insurance coverage, or 2. You have private insurance and your co-pay is greater than $130/month. Please note the following Terms and Conditions for the $30 co-pay category: a. No health insurance is accepted or required; b. Patients participating in this category cannot seek reimbursement for a purchase of LIPITOR from any third-party insurance entity during the term of this offer; c. Medicare Part D patients may participate in this card program, but cannot use any part of their Medicare Part D or prescription benefit for LIPITOR during the term of this offer; d. Out-of-pocket expenditures under this card program cannot be applied toward a patient s Medicare Part D true out-of-pocket (TrOOP) expenses. Q: Can I use my LIPITOR Savings Card if I don t have insurance? A: Yes. If you are eligible, no insurance is accepted or required for the $30 co-pay. Just take your activated card and prescription for LIPITOR to the pharmacy to get your 30-day supply for $30. Q: Does the card work with private or commercial health insurance? A: Yes, the LIPITOR Savings Card may work with insurance. Here are the details: Insured patients whose out-of-pocket cost for LIPITOR is $130 or less may pay $4 for a 30-day supply; Insured patients whose out-of-pocket cost for LIPITOR is more than $130 may pay $30 for a 30-day supply. Note that the $30 co-pay patients cannot seek reimbursement for a purchase of LIPITOR from any third-party insurance entity, including Medicare Part D, during the term of this offer. Q: I have Medicare Part D coverage. Can I use the LIPITOR Savings Card? A: Yes. If eligible, you will pay $30 for your 30-day supply of LIPITOR. However, you cannot use the LIPITOR Savings Card in conjunction with your Medicare Part D benefit. Out-of-pocket expenditures under this card program cannot be applied toward a patient s Medicare Part D true out-of-pocket (TrOOP) expenses. Please see full Prescribing and Patient Information for LIPITOR at LIPITOR.com. 3
4 Q: If I am eligible for the $30 co-pay and I am a Medicare Part D patient, can I use my insurance in combination with the LIPITOR Savings Card? A: No. Medicare Part D patients may participate in the LIPITOR Savings Card program but cannot use any part of their Medicare Part D prescription benefit for LIPITOR during the term of this offer. Q: I am a Medicaid recipient. Can I use the LIPITOR Savings Card? A: Unfortunately, Medicaid and other federal or state government insurance recipients are currently not eligible to participate. Q: How does someone get a LIPITOR Savings Card? A: It s easy. To see if you are eligible, answer a few questions on the Get a Card section of LIPITOR.com or call our toll-free number, How do I use the card? Q: Where can I use my LIPITOR Savings Card? A: You can use your card at any participating pharmacy. To find a pharmacy that has accepted a LIPITOR card, visit our Pharmacy Finder at LIPITOR.com. Q: Do I have to take my LIPITOR Savings Card to the pharmacy every time I pick up my prescription? A: Yes, be sure to present your activated card to your pharmacist when you drop off your prescription and every time you go to refill it, so your pharmacist knows that you want brand-name LIPITOR instead of the generic, atorvastatin calcium. Q: Do I need a new prescription to use the LIPITOR Savings Card? A: To use the LIPITOR Savings Card, all participants must have a valid prescription for brand-name LIPITOR. Be sure to ask your doctor to specify LIPITOR on your prescription with a note such as No Substitutions, Brand Medically Necessary, or Dispense As Written (DAW) to ensure you receive brand-name LIPITOR. Please see full Prescribing and Patient Information for LIPITOR at LIPITOR.com. 4
5 Q: Can I use the LIPITOR Savings Card on a previously filled prescription? A: No, the LIPITOR Savings Card can only be used for new prescriptions that are filled after you have activated the card. Q: How much will I pay for a 60- or 90-day prescription with the LIPITOR Savings Card? A: Depending on your cost ($4 or $30 for a 30-day supply), you will pay amounts directly related to the prescription duration you are purchasing. Therefore, if your out-of-pocket cost is $4, you will pay $8 for a 60-day supply and $12 for a 90-day supply. If your out-of-pocket cost is $30, you will pay $60 for a 60-day supply and $90 for a 90-day supply of LIPITOR. Q: Can I use the card more than once a month? Can I let someone else use it? A: You can only use the card once every 30 days. The card is for individual use only. Q: Is there a limit to how much I can use my card? A: Yes, you can only use the card for a maximum savings of $2500 per calendar year. Q: I have an older LIPITOR card (LIPITOR $4 Co-pay Card or 30 for $30 Card). Do these cards still work? A: Yes, these cards will still work. You may also sign up for the LIPITOR Savings Card on LIPITOR.com and enjoy the same benefits. Q: Does the LIPITOR Savings Card work with mail-order prescriptions? A: Yes. We ll reimburse you for the cost of your prescription over and above your eligible cost. Simply pay for your LIPITOR prescription and mail a copy of your original pharmacy receipt (cash register receipt NOT valid) with product name, date, and amount circled to: LIPITOR Savings Card 2250 Perimeter Park Drive, Suite 200 Morrisville, NC Please be sure to include a copy of the front of your LIPITOR Savings Card, your name, and your mailing address. All rebate submissions will be processed within 10 to 14 business days of the date we receive your information. Please see full Prescribing and Patient Information for LIPITOR at LIPITOR.com. 5
6 Q: Does Pfizer have a list of pharmacies that carry LIPITOR? A: Pharmaceutical companies do not maintain current lists of pharmacies that carry their products, since pharmacies and their wholesaler distributors decide which medicines to stock. To find a pharmacy near you that has recently carried LIPITOR, visit our Pharmacy Finder at LIPITOR.com. If your local pharmacy does not carry LIPITOR, you may ask if it s possible for them to order the brand for earliest possible pick-up. Make sure you leave enough time to fill your prescription so that you don t miss a dose, and continue to take your medication as prescribed by your doctor. Q: My doctor switched my LIPITOR prescription to the generic, atorvastatin calcium. Can I continue to use my LIPITOR Savings Card? A: No, but be sure to ask your doctor to specify LIPITOR on your prescription with a note such as No Substitutions, Brand Medically Necessary, or Dispense As Written (DAW) to ensure you receive brand-name LIPITOR instead of the generic, atorvastatin calcium. You will then be able to use your LIPITOR Savings Card. You can also ask your pharmacist to give you brand-name LIPITOR instead of the generic, atorvastatin calcium. Q: Can I use my LIPITOR Savings Card for other medications I am taking? A: No. Your card is for brand-name LIPITOR only. If you are interested in similar offers for other Pfizer products, visit Q: My current LIPITOR card ($4 or 30 for $30 card) expired. What do I need to do to get a new card? A: You may sign up for a new LIPITOR Savings Card on LIPITOR.com or get one from your doctor. Once your card is registered, present it at the pharmacy to enjoy the same benefits. Please see full Prescribing and Patient Information for LIPITOR at LIPITOR.com. 6
7 How much does it cost? Q: How much will I pay using the LIPITOR Savings Card? A: Eligible insured patients whose plans cover LIPITOR up to a $130 out-of-pocket cost will pay $4 for a 30-day supply; Eligible insured patients whose plans do not cover LIPITOR, or do not cover it over the $130 out-of-pocket cost, will pay $30 for a 30-day supply; Eligible uninsured patients, as well as Medicare Part D patients, will pay $30 for a 30-day supply. If you are not sure if your insurance company covers LIPITOR, you may contact them to find out how LIPITOR is covered under your specific plan. Q: Can I combine this with other coupon offerings or the LIPITOR $4 Co-pay Card? A: No. The LIPITOR Savings Card cannot be combined with any other co-pay card, rebate, coupon, free trial, or similar offer on the same prescription. By participating in this offer, you agree not to seek reimbursement from any third-party insurance entities. Q: Why would my co-pay change? A: Your co-pay is dependent upon your insurance coverage. If you lose insurance, change insurance companies, or your plan no longer covers LIPITOR, your co-pay is subject to change. Q: My pharmacist was unable to process my LIPITOR Savings Card. How do I receive my reimbursement? A: If you already filled your prescription, you can receive reimbursement via a mail-in rebate. In order to receive the mail-in rebate, please send a copy of your LIPITOR Savings Card and a copy of the original pharmacy receipt with the product name, date, and amount circled to: LIPITOR Savings Card 2250 Perimeter Park Drive, Suite 200 Morrisville, NC All rebate submissions will be processed within 10 to 14 business days of the date we receive your information. Be sure to include your name and your mailing address. Please see full Prescribing and Patient Information for LIPITOR at LIPITOR.com. 7
8 Pharmacy information Q: What happens when I go to the pharmacy? A: You will present the activated card to the pharmacist when you request your prescription or refill. Your pharmacist will then process your LIPITOR Savings Card as necessary. Because this program works differently from other cards, pharmacists may not be familiar with how to process it. They can check the instructions on the card or call Q: What does it mean if my pharmacist says that I have to get No Substitutions, Brand Medically Necessary, or Dispense As Written (DAW) on my script to receive brand-name LIPITOR instead of the generic, atorvastatin calcium? A: Be sure to ask your doctor to specify LIPITOR on your prescription with a note such as No Substitutions, Brand Medically Necessary, or Dispense As Written (DAW) to ensure you receive brand-name LIPITOR at the pharmacy and not the generic, atorvastatin calcium. Your pharmacist may be able to call your doctor to see if you can be switched to brand-name LIPITOR. Once switched, if eligible, you will be able to use your LIPITOR Savings Card. Q: What happens if my local pharmacy does not have LIPITOR in stock? A: If your local pharmacy does not carry LIPITOR, you may ask if it s possible for them to order the brand for the earliest possible pick-up. Make sure you leave enough time to fill your prescription so you don t miss a dose, and continue to take your medication as prescribed by your doctor. Q: My pharmacist switched my LIPITOR prescription to the generic, atorvastatin calcium. Can I continue to use my LIPITOR Savings Card? A: No. You can t use this card with the generic version. But you can let your pharmacist know that you want brand-name LIPITOR. Your pharmacist can then switch you back to brand-name LIPITOR, which will allow you to use the card if you are eligible. For more information, please call or visit LIPITOR.com. Please see full Prescribing and Patient Information for LIPITOR at LIPITOR.com. 8
9 INDICATION LIPITOR (atorvastatin calcium) is a prescription medicine that lowers cholesterol in the blood. It lowers the LDL-C ( bad cholesterol) and triglycerides in your blood. It can raise your HDL-C ( good cholesterol) as well. LIPITOR is for adults and children over 10 whose cholesterol does not come down enough with exercise and a low-fat diet alone. LIPITOR can lower the risk for heart attack, stroke, certain types of heart surgery, and chest pain in patients who have heart disease or risk factors for heart disease such as age, smoking, high blood pressure, low HDL-C, or heart disease in the family. LIPITOR can lower the risk for heart attack or stroke in patients with diabetes and risk factors such as eye problems, kidney problems, smoking, or high blood pressure. IMPORTANT SAFETY INFORMATION LIPITOR (atorvastatin calcium) tablets are not for everyone, including anyone who has previously had an allergic reaction to LIPITOR. It is not for those with liver problems. And it is not for women who are nursing, pregnant, or may become pregnant. If you take LIPITOR (atorvastatin calcium) tablets, tell your doctor if you feel any new muscle pain or weakness. This could be a sign of rare but serious muscle side effects. Tell your doctor about all your medical conditions and all medications you take. This may help avoid serious drug interactions. Your doctor should do blood tests to check your liver function before starting LIPITOR and during your treatment if you have symptoms of liver problems. Tell your doctor if you have diabetes. Elevated blood sugar levels have been reported with statins, including LIPITOR. Common side effects are diarrhea, upset stomach, muscle and joint pain, and changes in some blood tests. Patients should always ask their doctors for medical advice about adverse events. You may report an adverse event related to Pfizer products by calling (US only). If you prefer, you may contact the US Food and Drug Administration (FDA) directly. The FDA has established a reporting service known as MedWatch where healthcare professionals and consumers can report serious problems they suspect may be associated with the drugs and medical devices they prescribe, dispense, or use. Visit or call FDA Please see full Prescribing and Patient Information for LIPITOR at LIPITOR.com. 9
10 *LIPITOR SAVINGS CARD TERMS AND CONDITIONS By using the LIPITOR Savings Card (the Card ), you attest that you meet the eligibility criteria and will comply with the Terms and Conditions described below: You will pay $4 for a 30-day supply (30 tablets) if: you use commercial/private insurance and your out-of-pocket expense for a 30-day supply of brand-name LIPITOR is $130 or less. You will pay $30 for a 30-day supply (30 tablets) if: you do not use prescription health coverage to purchase your brand-name LIPITOR under this program or you use commercial/private insurance and your out-of-pocket expense for a 30-day supply of brand-name LIPITOR is $130 or more. In addition: a) Medicare Part D patients may participate in this Card Program, but cannot use any part of their Medicare Part D prescription benefit for LIPITOR during the term of this offer. b) Out-of-pocket expenditures under this Card Program cannot be applied towards a patient s Medicare Part D true out of pocket (TrOOP) expenses. c) Patients participating in this category cannot seek reimbursement for a purchase of LIPITOR from any third party insurance entity during the term of this offer. This offer is not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid or other federal or state healthcare programs (including any state prescription drug assistance programs and the Government Health Insurance Plan available in Puerto Rico [formerly known as La Reforma de Salud ]). For all eligible patients, you can only qualify for up to $2500 of savings per calendar year. After a maximum of $2500, you will pay usual monthly out-of-pocket costs. This Card cannot be combined with any other rebate/coupon, free trial, discount, prescription savings card, or similar offer for the specified prescription. The Card will be accepted only at participating pharmacies. This Card is not health insurance. Offer valid only in the U.S. and Puerto Rico, but not for Massachusetts residents or where otherwise prohibited by law. The Card is limited to 1 use per person per month during this offering period and is not transferable. It is illegal to sell, purchase, trade, or counterfeit, or offer to sell, purchase, trade, or counterfeit this Card. Pfizer reserves the right to rescind, revoke or amend the Card Program without notice at any time. You must be 18 or older to participate in this Program. Card Program expires December 31, No membership fees. For reimbursement when using mail order, mail copy of original pharmacy receipt (cash register receipt NOT valid) with product name, date and amount circled to: LIPITOR Savings Card 2250 Perimeter Park Drive, Suite 200 Morrisville, NC Be sure to include a copy of the front of your Savings Card, your name and mailing address. Please see full Prescribing and Patient Information for LIPITOR at LIPITOR.com. 10 PP-LIP-USA Pfizer Inc. All rights reserved. March 2016
Frequently Asked Questions (FAQs) About the LIPITOR Savings Program*
Frequently Asked Questions (FAQs) About the LIPITOR Savings Program* *Terms and conditions apply. Please see page 9 for details. You may pay less by receiving the generic. Below are some FAQs about the
More informationGet a 1-month supply of ENTRESTO at no cost to you *
Get a 1-month supply of ENTRESTO at no cost to you * FREE TRIAL OFFER * For all patients A program designed to guide you through treatment *Limitations apply. This voucher is good for a 30-day (maximum
More informationPay as little as a $10 co-pay a month for ENTRESTO *
Pay as little as a $10 co-pay a month for ENTRESTO * $10 CO-PAY CARD * For eligible commercially insured patients A program designed to guide you through treatment *Limitations apply. This offer is not
More informationGet a 1-month supply of ENTRESTO at no cost to you*
Get a 1-month supply of ENTRESTO at no cost to you* FREE TRIAL OFFER * For all patients A program designed to guide you through treatment *Limitations apply. This voucher is good for a 30-day (maximum
More informationOVERVIEW PROCESS SERVICES HARVONI. Simply on Your Side. Please see full Prescribing Information, including Patient Information.
HARVONI Simply on Your Side. OVERVIEW PROCESS SERVICES A breakthrough treatment with exceptional support Living with hepatitis C (Hep C) can come with a lot of uncertainty. But getting started with Hep
More informationPERSONAL SUPPORT PROGRAM SERVICES AND SUPPORT TO HELP YOU GET STARTED
PERSONAL SUPPORT PROGRAM SERVICES AND SUPPORT TO HELP YOU GET STARTED GETTING STARTED WITH COSENTYX Find out how to get started, what to expect, and how the COSENTYX Connect Personal Support program can
More informationNeedyMeds
NeedyMeds www.needymeds.org Find help with the cost of medicine Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need.
More informationCelgene Patient Support Learn about financial help for IDHIFA
Celgene Patient Support Learn about financial help for IDHIFA A Celgene Patient Support Specialist can help you and your loved ones understand the programs and services available to you. CELGENE PATIENT
More informationNeedyMeds
NeedyMeds www.needymeds.org Find help with the cost of medicine Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need.
More informationPLEASE CHECK ALL BOXES THAT APPLY AND COMPLETE THE APPROPRIATE SECTION(S) OF THE FORM
The Merck Access Program 2019 ENROLLMENT FORM Phone: 855-257-3932, Fax: 855-755-0518 The Merck Access Program, PO Box 29067, Phoenix, AZ 85038 TO GET STARTED, COMPLETE THE ENROLLMENT FORM AND FAX IT TO
More informationMoving from Pediatric to Adult Care: Prescription Medicines, Supplies, and Equipment
Moving from Pediatric to Adult Care: Prescription Medicines, Supplies, and Equipment To take care of your own health, you need to know how to fill prescriptions. Most prescriptions for medicines can be
More informationThank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need.
Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need. Did you know that NeedyMeds has thousands of other free resources?
More informationCelgene Patient Support Learn about financial help for REVLIMID
Celgene Patient Support Learn about financial help for REVLIMID A Celgene Patient Support Specialist can help you and your loved ones understand the programs and services available to you. At Celgene,
More informationPrescription Savings Club
Prescription Savings Club Enroll in-store or online at walgreens.com/rxsavingsclub Join the millions of people already saving! Whether or not you have prescription insurance, you could save with Walgreens
More informationCelgene Patient Support Learn about financial help for POMALYST
Celgene Patient Support Learn about financial help for POMALYST A Celgene Patient Support Specialist can help you and your loved ones understand the programs and services available to you. At Celgene,
More informationPLEASE CHECK ALL BOXES THAT APPLY AND COMPLETE THE APPROPRIATE SECTION(S) OF THE FORM. Patient name: _Date of birth: Sex: M F
The Merck Access Program ENROLLMENT FORM Phone: 855-257-3932, Fax: 855-755-0518, TTY: 855-257-7332 The Merck Access Program, PO Box 29067, Phoenix, AZ 85038 TO GET STARTED, COMPLETE THE ENROLLMENT FORM
More informationContents General Information General Information
Contents General Information... 1 Preferred Drug List... 2 Pharmacies... 3 Prescriptions... 4 Generic and Preferred Drugs... 5 Express Scripts Website and Mobile App... 5 Specialty Medicines... 5 Prior
More informationCelgene Patient Support Learn about financial help for ABRAXANE
Celgene Patient Support Learn about financial help for ABRAXANE A Celgene Patient Support Specialist can help you and your loved ones understand the programs and services available to you. We know paying
More informationIntel Corporation Connected Care Arizona Care Network
Intel Corporation Connected Care Arizona Care Network Prescription Benefits Managed by Express Scripts Member Services: 855.315.4523 Member Website: connectedcarehealth.com (follow the links to the prescription
More informationNeedyMeds
NeedyMeds www.needymeds.org Find help with the cost of medicine Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need.
More informationNeedyMeds
NeedyMeds Find help with the cost of medicine Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need. REMEMBER - Send your
More informationSAVINGS GUARANTEED FEEL BETTER. This Program is NOT Insurance. Membership
FEEL BETTER GUARANTEED SAVINGS This Program is NOT Insurance. Membership fee required ($20 individual or $35 family per year). Persons receiving benefits from Medicare, Medicaid or other government-funded
More informationGROUP INSURANCE. Generic drugs. Their positive effect on your wallet
GROUP INSURANCE Generic drugs Their positive effect on your wallet A wise choice Prescription drugs have a couple of things in common: they re designed to heal us or make us feel better, and most of them
More informationMedicare s new prescription drug insurance called
KENTUCKY Medicare s new prescription drug insurance called Medicare Part D began January 1, 2006. To get this insurance, most people will have to sign up for one of the Part D Plans Medicare has approved.
More information2018 FAQs. Prescription drug program. Frequently Asked Questions from employees
2018 FAQs Prescription drug program Frequently Asked Questions from employees September 2017 Prescription drug program Questions we ve heard our employees ask Here are some commonly asked questions about
More informationFREQUENTLY ASKED QUESTIONS ABOUT THE CVS CAREMARK PRESCRIPTION DRUG PROGRAM
FREQUENTLY ASKED QUESTIONS ABOUT THE CVS CAREMARK PRESCRIPTION DRUG PROGRAM ABBVIE EMPLOYEES WANT TO KNOW 2018 Pharmacy Benefit Changes Q. What is the new prior authorization program? A. Certain brand
More informationQuestions and Answers. When should I use mail order pharmacy services? What is my co payment for drugs? What is my co payment for preferr
WPDP/Moda Health Pharmacy Program Welcome to your new pharmacy program, offered through the Washington Prescription Drug Program (WPDP) and administered by Moda Health, formerly ODS Health. At Moda Health,
More informationThank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need.
Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need. Did you know that NeedyMeds has thousands of other free resources?
More informationMedicare s new prescription drug insurance called
NORTH DAKOTA Medicare s new prescription drug insurance called Medicare Part D began January 1, 2006. To get this insurance, most people will have to sign up for one of the Part D Plans Medicare has approved.
More informationThe Merck Access Program ENROLLMENT FORM
The Merck Access Program ENROLLMENT FORM P: 877-709-4455 F: 800-977-1957 The Merck Access Program, PO Box 29067, Phoenix, AZ 85038 TO GET STARTED, COMPLETE THE ENROLLMENT FORM AND FAX IT TO 800-977-1957.
More informationNeedyMeds
NeedyMeds www.needymeds.org Find help with the cost of medicine Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need.
More informationDoD NAF HBP. Retirees, Medicare and Aetna AREA Luncheon
DoD NAF HBP Retirees, Medicare and Aetna AREA Luncheon Agenda Medicare and DoD NAF HBP/Aetna Coverage of Flu, Pneumonia, and Shingles Shots Maintenance Choice NEW for 2017 Exclusions Drug List NEW for
More informationPLEASE CHECK ALL BOXES THAT APPLY AND COMPLETE THE APPROPRIATE SECTION(S) OF THE FORM. Patient name: Date of birth: Sex: M F
TM RENFLEXIS for injection (inf liximab-abda)100 mg The Merck Access Program ENROLLMENT FORM Before prescribing RENFLEXIS, please read the accompanying Prescribing Information, including the Boxed Warning
More informationNeedyMeds
NeedyMeds www.needymeds.org Find help with the cost of medicine Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need.
More informationWORKSAFENB DIRECT-PAY PRESCRIPTION DRUG PROGRAM
WORKSAFENB DIRECT-PAY PRESCRIPTION DRUG PROGRAM WHAT IS THE WORKSAFENB DIRECT-PAY PRESCRIPTION DRUG PROGRAM? It is an online prescription drug program available in all pharmacies throughout New Brunswick
More informationA Quick Start Guide to Your New Health Plan
A Quick Start Guide to Your New Health Plan You Are Here Verification Letter Approval Letter ID Card & Quick Start Guide SCAN Membership Begins Welcome Call/ TeleTalk SCAN Club Newsletter Get your plan
More informationHealth Care in California: The Chronically Ill
Health Care in California: The Chronically Ill A report for the California HealthCare Foundation prepared by Prepared for the California HealthCare Foundation by Harris Interactive Contents About this
More informationYour. Multi-tiered. Prescription Drug Benefit Program. bcnepa.com
Your Multi-tiered Prescription Drug Benefit Program bcnepa.com What you need to know about your multi-tiered prescription drug program A formulary is our list of covered drugs and supplies organized by
More informationLynn Hutchins Psychiatric Nurse Practitioner, PLLC
We look forward to working with you and getting to know you! It is our goal to provide the best mental health care, as well as making your visits here pleasant, courteous and as efficient as possible.
More informationUSES: This medication is used along with a non-drug program (including diet changes) to treat cholesterol and lipid disorders.
Fenofibrate Capsule, Fenofibrate Capsule India, Fenofibrate Capsule manufacturers India, side effects Fenofibrate Capsule manufacturers, Taj Pharma India, Fenofibrate Capsule overdose, Fenofibrate Capsule
More informationAllergies None Penicillin Sulfa Drugs Codeine Aspirin Tape Latex Iodine-Shellfish. Other allergies: Medications
Today s Date: Height Weight Shoe size (CIRCLE) Allergies None Penicillin Sulfa Drugs Codeine Aspirin Tape Latex Iodine-Shellfish Other allergies: Medications SOCIAL HISTORY (CIRCLE) Do you smoke? No Yes
More informationXEOMIN (incobotulinumtoxina) PATIENT SAVINGS PROGRAM
XEOMIN (incobotulinumtoxina) PATIENT SAVINGS PROGRAM For patients who qualify, Merz will reimburse eligible actual out-of-pocket XEOMIN medication costs and related administration fees Eligible patients
More informationPatient Registration Form
Patient Registration Form Please bring insurance card and photo ID to your appointment Patient Name of Birth Today s Address City State Zip Home Phone Cell # Work # Circle your contact preference: Home
More informationMedicare Notebook. Helping you make sense of Medicare
Medicare Notebook Helping you make sense of Medicare Hello! Welcome to your Medicare Notebook Whether you re looking for a change or are new to Medicare, this handy guide gives you clear information, helpful
More informationDrug coverage in New Brunswick
Drug coverage in New Brunswick The majority of New Brunswickers receive drug coverage through publicly-funded drug programs (like the New Brunswick Prescription Drug Program) or through private drug plans.
More informationNeedyMeds
NeedyMeds www.needymeds.org Find help with the cost of medicine Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need.
More informationNeedyMeds
NeedyMeds www.needymeds.org Find help with the cost of medicine Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need.
More informationNeedyMeds
NeedyMeds www.needymeds.org Find help with the cost of medicine Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need.
More informationPharmacy Coverage Guidelines are subject to change as new information becomes available.
(atorvastatin, fluvastatin, fluvastatin er, lovastatin, pravastatin, and simvastatin) Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in
More informationMedicare s new prescription drug insurance called
MISSISSIPPI Medicare s new prescription drug insurance called Medicare Part D began January 1, 2006. To get this insurance, most people will have to sign up for one of the Part D Plans Medicare has approved.
More informationIntroducing the benefits of the HDHP. Get the most out of the High Deductible Health Plan
Introducing the benefits of the HDHP Get the most out of the High Deductible Health Plan HDHP Comparing the HDHP to Lehigh s other health plan offerings. There are many similarities between the HDHP and
More informationEndocrinology of the Rockies, PC. PATIENT REGISTRATION FORM E. 9th Ave. Ste. 245, Denver, CO 80220
1 PATIENT REGISTRATION FORM 2018 4545 E. 9th Ave. Ste. 245, Denver, CO 80220 Patient Name (Last, First, M.I.): Prefer to be called: Address: City: State: Zip: Home phone: ( ) Work phone: ( ) Day phone:
More informationfax. FAX completed and signed enrollment form to BMS Access Support at
Simple Steps to Enroll Physician o o o Complete the Services and Treatment sections on page 1 Complete the Physician Information section on page 2 Read, sign, and date Physician Certification on page 2
More informationThank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need.
Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need. Did you know that NeedyMeds has thousands of other free resources?
More informationGetting Started with Medicare
Getting Started with Medicare TABLE OF CONTENTS 2 What is Medicare? 3 Original Medicare Parts A and B 5 Medicare Part C Medicare Advantage Plans 6 Medicare Part D Prescription Drug Coverage 8 How to Enroll
More informationThank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need.
Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need. Did you know that NeedyMeds has thousands of other free resources?
More informationGetting Started with Medicare
Getting Started with Medicare TABLE OF CONTENTS 2 What is Medicare? 3 Original Medicare Parts A and B 5 Medicare Part C Medicare Advantage Plans 6 Medicare Part D Prescription Drug Coverage 8 How to Enroll
More informationNeedyMeds
NeedyMeds www.needymeds.org Find help with the cost of medicine Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need.
More informationYour medicine, your way. Start using home delivery today.
Your medicine, your way. Start using home delivery today. Health benefits and health insurance plans contain exclusions and limitations. Aetna Rx Home Delivery refers to Aetna Rx Home Delivery, LLC, a
More informationCENTER CITY DERMATOLOGY STEPHEN HESS, M.D., Ph.D. MEDICAL HISTORY
CENTER CITY DERMATOLOGY STEPHEN HESS, M.D., Ph.D. MEDICAL HISTORY Name Age Date of Birth Email _ Reason for today s visit Who referred you to this office _ Who is your primary care physician? Are you allergic
More informationFor households exceeding 4 members, add $21,600 for each additional member to the $125,500 referenced above.
Do I qualify for PASS? Patient Assistance Program Enrollment Form Need help paying for your medicine? In many cases, we can help. PASS has a financial solution for eligible patients, regardless of your
More informationPATIENT REGISTRATION
PATIENT REGISTRATION Last Name First Name Middle or Maiden Mailing Address City County State Zip Physical Address (if different) Telephone: Home( ) Cell ( ) Work ( ) Preferred Contact: Home Cell Text Message
More informationMedicare s new prescription drug insurance called
COLORADO Medicare s new prescription drug insurance called Medicare Part D began January 1, 2006. To get this insurance, most people will have to sign up for one of the Part D Plans Medicare has approved.
More informationYour Pharmacy Benefits Handbook
Your Pharmacy Benefits Handbook Summary of FCPS Prescription Benefits Available Through CVS Caremark Pharmacy Benefit Manager for Aetna/Innovation Health and CareFirst BlueChoice Advantage Plans Plan Year
More informationPrior Authorization Required From DXC Technology
There are nine situations where prior authorization must be requested from DXC Technology. Brand Medically Necessary Prescriptions written as "Brand Medically Necessary" for drugs with A-rated therapeutically
More informationPATIENT INFORMATION NOTICE OF PRIVACY POLICY PATIENT ACKNOWLEDGEMENT
PATIENT INFORMATION ( MR / MRS / MS / DR ) FIRST MIDDLE LAST DATE OF BIRTH AGE MARITAL STATUS (circle one) Married / Divorced / Single / Widowed STREET ADDRESS APT/LOT/ROOM/SUITE CITY STATE ZIP GENDER
More informationPicking a Medicare Prescription Drug Plan Basic facts you need to know and questions you should ask
Picking a Medicare Prescription Drug Plan Basic facts you need to know and questions you should ask This guide has been provided by the editors of Pharmacist s Letter and Prescriber s Letter for your pharmacist
More informationPATIENT REGISTRATION AND HISTORY FORM ~ FAMILY EYE HEALTH ASSOCIATES
PATIENT REGISTRATION AND HISTORY FORM ~ FAMILY EYE HEALTH ASSOCIATES PATIENT INFORMATION: Name (Last, First, MI) Date: Address: City State Zip Home Phone 2nd Phone Work Cell E-Mail Gender: M F Birthdate
More informationJanuary 1 December 31, 2013 Evidence of Coverage: Your Medicare Prescription Drug Coverage as a Member of Express Scripts Medicare
The Centers for Medicare & Medicaid Services (CMS) requires that we send you certain plan materials upon your enrollment in a Medicare Part D plan and annually thereafter. The enclosed Evidence of Coverage
More informationGetting started with Medicare
Getting started with Medicare Look inside to: Learn about Medicare Find out about coverage and costs Discover when to enroll Medicare Made Clear Learning about Medicare can be like learning a new language.
More informationNeedyMeds
NeedyMeds www.needymeds.org Find help with the cost of medicine Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need.
More informationThank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need.
Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need. Did you know that NeedyMeds has thousands of other free resources?
More informationThank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need.
Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need. Did you know that NeedyMeds has thousands of other free resources?
More informationPatient Information. Financial Handbook For Liver Transplant Patients
Patient Information Financial Handbook For Liver Transplant Patients Beaumont Transplant Clinic Directory Beaumont Hospital, Royal Oak Medical Office Building 3535 West 13 Mile Road, Suite 644 Royal Oak,
More informationSBCFF Modified Rx 10/30/45 Prescription Drug Benefits
Rx Benefits SBCFF Modified Rx 10/30/45 Prescription Drug Benefits This summary of benefits has been updated to comply with federal and state requirements, including applicable provisions of the recently
More informationNews and Updates on Your Health Benefits Program
News and Updates on Your Health Benefits Program DoD NAF Open Enrollment: Nov ember 2 27, 2015 Take charge of your health care costs This newsletter contains information and important changes to your DoD
More informationHealthyYou. New! Receive Your Plan Materials Electronically! Taking Medications as Prescribed page 2. Create Your InTouch Account page 4
Taking Medications as Prescribed page 2 For added convenience, you can now choose to receive your annual plan materials electronically. We know life is busy. Opting-in to receive your annual plan materials
More informationTrustees Announce New Programs to Save Members of-pocket Expense
PHILADELPHIA Official Publication of Teamsters Health & Welfare and Pension Funds of Philadelphia and Vicinity www.teamsterfunds.com March 2008 Trustees Announce New Programs to Save Members Out-of of-pocket
More informationPfizer encompass Co-Pay Assistance Program for INFLECTRA :
Pfizer encompass Co-Pay Assistance Program for INFLECTRA : Guide to Claim Submission and Payment INFLECTRA is a trademark of Hospira UK, a Pfizer company. Pfizer encompass is a trademark of Pfizer. Table
More informationMedical Plan User Guide
Ventura EPO Medical Plan User Guide EFFECTIVE JANUARY 1, 2019 Your health. Your benefits. Your choice. Dignity Health Medical Plan User s Guide Dignity Health is committed to offering you comprehensive,
More informationYour Health Insurance: Questions and Answers
Your Health Insurance: Questions and Answers This simple guide will help you understand how to use and keep your health insurance Meet four people with questions about their health insurance: George is
More informationNeedyMeds
NeedyMeds www.needymeds.org Find help with the cost of medicine Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need.
More informationA CONSUMER S GUIDE TO CANCER INSURANCE
A CONSUMER S GUIDE TO CANCER INSURANCE WHAT IS CANCER INSURANCE? Cancer insurance provides benefits only if you are diagnosed with cancer, as defined by the terms of the policy contract. These policies
More informationPatient Resource Guide
Access Services Patient Resource Guide AstraZeneca Access 360 is committed to helping you access our medicines. This guide will provide you with information and resources to help you understand how to
More informationYour Guide to Medicare Special Needs Plans (SNPs)
CENTERS FOR MEDICARE & MEDICAID SERVICES Your Guide to Medicare Special Needs Plans (SNPs) This official government booklet has important information about Medicare Special Needs Plans, including the following:
More informationAsuris Northwest Health Medicare Advantage PPO Plans. Decision Guide
2016 Northwest Health Medicare Advantage PPO Plans Decision Guide STEP-BY-STEP STEP 1 STEP 2 STEP 3 STEP 4 READ. Learn about all the programs and benefits you can enjoy as an Northwest Health member. This
More informationDEFICIT REDUCTION ACT AND FALSE CLAIMS POLICY INFORMATION FOR All MASSACHUSETTS WORKFORCE MEMBERS
DEFICIT REDUCTION ACT AND FALSE CLAIMS POLICY INFORMATION FOR All MASSACHUSETTS WORKFORCE MEMBERS The Company is committed to preventing health care fraud, waste and abuse and complying with applicable
More informationAll About. RX Drugs. And What. You Need. Now HEALTHY SMART
All About RX Drugs 2013 What s New And What You Need To Do Now HEALTHY SMART An apple a day is good advice. And so is managing our prescription drug costs which totaled nearly $12 million last year alone.
More informationPHARMACY BENEFIT MEMBER BOOKLET
PHARMACY BENEFIT MEMBER BOOKLET Printed on: VALUE, QUALITY AND CONFIDENCE Costco Health Solutions Customer Care HOURS: 24 Hours a Day 7 Days a Week (877) 908-6024 (toll-free) TTY 711 MAILING ADDRESS: Costco
More informationPatient Registration Form
Patient Registration Form PATIENT INFORMATION Please Print Last Name: First: M.I. Mailing Address: City: State: Zip Code: Date of Birth: Gender: M F Married Single Widowed Divorced Separated Partnered
More informationFREQUENTLY ASKED QUESTIONS
Pfizer Medicare-Eligible Prescription Drug Coverage FAQs 2016 Annual Enrollment Period October 2015 FREQUENTLY ASKED QUESTIONS These FAQs provide information about the Jan. 1, 2016 move to SilverScript
More information2345 Court Drive Gastonia, NC Phone: Fax:
Patient Name: Address: Street City State Zip SSN: Home #: Birth Age: Sex: Male Female Email Address: Marital Status: Single Married Divorced For X-ray purposes, are you pregnant? Yes No Patient s Employer:
More informationMedicine and Surgery of the Foot PATIENT INFORMATION PERSON RESPONSIBLE FOR PAYING THE BILL FAMILY PHYSICIAN INFORMATION HEALTH INSURANCE INFORMATION
PATIENT REGISTRATION Thank you for choosing our office! Please complete all pages. Patient Name: PATIENT INFORMATION Home Address: City: State: Zip: Sex: S S#: Marital Status: S,M,O or minor E-mail: Home
More informationFair Drug Prices for Nova Scotians
Fair Drug Prices for Nova Scotians September 2010 Fair Drug Prices for Nova Scotians September 2010 The Problem Nova Scotians pay too much for prescription drugs. In Nova Scotia, we pay more for generic
More informationPrescription Drug Coverage
CENTERS FOR MEDICARE & MEDICAID SERVICES Your Guide to Medicare Prescription Drug Coverage This official government booklet tells you about how Medicare prescription drug coverage works. extra help for
More informationMedicare Made Simple
Medicare Made Simple TABLE OF CONTENTS 2 What is Medicare? 3 Original Medicare Parts A and B 5 Medicare Part C Medicare Advantage Plans 6 Medicare Part D Prescription Drug Coverage 8 How to Enroll 10 Medicare
More informationDecision Guide Regence Medicare Advantage HMO Plan
2016 Decision Guide Regence Medicare Advantage HMO Plan Regence BlueShield serves select counties in the state of Washington and is an Independent Licensee of the Blue Cross and Blue Shield Association
More informationThank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need.
Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need. Did you know that NeedyMeds has thousands of other free resources?
More informationEmergency Room Visit Covered Only If It s A True Emergency. Pre-Certify Non-Emergency Hospital. Stays As Well As Emergency Stays
Not every article in this newsletter applies to you. Please check your Plan of Benefits first. For Your Benefit The Warehouse Employees Union Local No. 730 Trust Funds www.associated-admin.com October
More informationThank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need.
Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need. Did you know that NeedyMeds has thousands of other free resources?
More information