This coupon is not insurance.
Eligible patients may get Ranexa
for as little as $5 per month.
Up to $70 per month. You can use your card a maximum of
12 times a year for an annual benefit of $840.
Your personal information is required for security purposes
and is only used to confirm your identity as a card holder.
You are eligible for the co-pay coupon program if you:
- Have commercial prescription drug insurance coverage that does not cover all of your out-of-pocket cost
- Have commercial prescription drug insurance coverage that does not cover Ranexa
- Have no insurance
You are not eligible if
you are enrolled in a government healthcare prescription drug program, such as Medicare Part D or Medicaid.
Also, if you are in the Medicare Part D coverage gap, or "donut hole," you are not eligible. Other financial assistance
may be available for you. To learn more, please call Ranexa Connect at 1-888-726-3925.
Please note: The same coupon offer may be available in different forms. For example, you may receive
the coupon from your doctor, or you may print it yourself from the product Web site. Regardless of how many coupons you receive
or print, you may only use the coupon and save on your out-of-pocket cost over $5 on up to 12 eligible prescriptions before the
expiration date printed on the coupon. Up to $70 a month, for a maximum total annual benefit of $840 per patient.
Terms and Conditions
- The Gilead Co-pay Coupon Card ("Card") can be used only by eligible residents of the U.S., Puerto Rico, or U.S. territories at participating eligible retail, specialty, or mail-order
pharmacies in the U.S., Puerto Rico, or U.S. territories. Product must originate in the U.S. or Puerto Rico, or U.S. territories. You must be 18 years or older to use the
Card for yourself or a minor.
- The Card is limited to one per person and is not transferable. No substitutions are permitted. This Card is available for each valid prescription.
The offer cannot be combined with any other coupon, free trial, discount, prescription savings card, or other offer. Patient may not be currently receiving free drug assistance
through Gilead Sciences, Inc. ("Gilead")'s patient assistance programs.
- The Card is not insurance and is not intended to substitute for insurance.
- The Card is valid only for patients with commercial insurance or cash-pay patients and is not valid for prescriptions that are eligible to be reimbursed:
-in whole or part, by Medicare, Medicaid or a Medicare Part D plan, TRICARE, VA, DoD, Puerto Rico Government Health Insurance Plan
("Healthcare Reform"), or any other federal or
state-funded healthcare benefit program (collectively, "Government Programs"); or
-by commercial plans or other health or pharmacy benefit programs that reimburse for the entire cost of prescription drugs.
- Patients without insurance coverage or who have commercial insurance that does not cover the Gilead products are considered "cash-pay" patients. Medicare Part D
enrollees who are in the prescription drug coverage gap (the "donut hole") are not considered cash-pay, and are not eligible to use the Card. Patients who begin receiving
prescription benefits from such Government Programs at any time will no longer be eligible to use the Card. Void where prohibited by law, taxed, or restricted.
- Patient, pharmacist, and prescriber agree not to seek reimbursement for all or any part of the benefit received by the patient through the offer. Both patient and pharmacist are
each individually responsible for reporting receipt of coupon benefit to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription
filled using the Card, as required.
- It is illegal to sell, purchase, trade, or counterfeit, or offer to sell, purchase, trade, or counterfeit the Card.
- Certain information pertaining to your use of the Card will be shared with Gilead, the sponsor of the Card, and its affiliates.
The information disclosed will include the date the prescription is filled, the number of pills or product dispensed by the pharmacists,
- Gilead reserves the right to terminate, rescind, revoke, or modify this Card at any time without notice.
Ranexa is a prescription medication. Only your healthcare provider can decide whether Ranexa is right for you. Please see full
Prescribing Information including Patient Information for Ranexa (ranolazine).