Reprint Your Card
Savings Card Terms and Conditions
Limitations apply. This card is valid for up to $100 off each of up to 12 qualifying prescriptions of UTIBRON for up to a 30-day supply. Valid only for those with commercial insurance. Offer not valid under Medicare, Medicaid, or any other federal or state program. Cash-paying patients will save up to $100 off the cost of their prescription. Offer is not valid where prohibited by law. Valid only in the US and Puerto Rico. This program is not health insurance. This card is the property of Sunovion Pharmaceuticals Inc. and must be returned upon request. Offer may not be combined with any other rebate, coupon, or offer.
To the Patient: You must present this card 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 UTIBRON NEOHALER Co-pay Card program at 844-276-8262 (8am-8pm ET Monday through Friday). When you use this card, you are certifying that you understand the program rules, regulations, and Terms and Conditions. You are not eligible if prescriptions are paid for by any state or other federally funded programs, including, but not limited to Medicare or Medicaid, Medigap, VA, DOD or TriCare, or where prohibited by law; and you will otherwise comply with the terms above.
To the Pharmacist: When you use this card, 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
- If primary commercial prescription insurance 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 card and your submission of claims for the UTIBRON NEOHALER Co-pay Card program are subject to the LoyaltyScript® program Terms and Conditions posted at www.mckesson.com/mprstnc
- Patient is not eligible if prescriptions are paid for in part or full by any state or federally funded programs, including but not limited to Medicare or Medicaid, Medigap, VA, DOD or TriCare, or where prohibited by law
- For questions regarding setup, claim transmission, patient eligibility or other issues, call the LoyaltyScript® for UTIBRON NEOHALER program at 844-276-8262 (8am-8pm ET Monday through Friday)
Sunovion Pharmaceuticals Inc. reserves the right to rescind, revoke, or amend this offer at any time.
Free Trial Offer Terms and Conditions
Limit One TrialScript® voucher per patient. Redeem for product only when affixed to the back of a valid, signed prescription form for UTIBRON NEOHALER. Submit claim to McKesson Corporation using BIN #610524. For pharmacy processing questions, please call the Help Desk at 1-800-657-7613.
To the Patient: This voucher is good for one 30-day free trial of UTIBRON NEOHALER. Present this voucher at a participating pharmacy along with a valid prescription from your health care professional. Need help? Call 1-800-657-7613.
To the Pharmacist: Must be accompanied by a valid prescription for one 30-day supply of UTIBRON NEOHALER. Dispense as written at no cost to patient. For reimbursement, please submit to McKesson Corporation. The information provided above should be used when submitting for reimbursement. Do not submit to any other payer, public or private, for reimbursement. This voucher can be used up to 2 times (once per 12-month period).
For questions, please call the Help Desk at 1-800-657-7613.
No substitutions permitted. No purchase required. This is not a discount or rebate. Limitations apply.
Expiration Date: 03/31/2018.
TrialScript® is a registered trademark of McKesson Corporation.