•Eligible patients pay as little as $15 per month; limit one 30day supply per prescription
•Patient must have a minimum outofpocket costs of $15.01 to redeem
•Maximum benefits per claim and per calendar year apply
•Patients will be responsible for any outofpocket costs above the maximum annual and monthly program benefit
•Card is valid through December 31 of the year of activation; On January 1 of the following year, the card automatically resets and is subject to annual limits if the prescription benefit remains the same
•For assistance or additional information, call 8554525234, Monday through Friday, 8 am–8 pm ET