• 1 Enter Details
  • 2 Confirmation of
    Card Replacement
Momentum Card Card ID

Please enter the information below to replace your Momentum Savings Card.

*All fields are required

Phone number is a required field.

Phone number must be 10 digits in length.

Phone number is restricted to 10 digits in length.

Date of Birth is a required field.

Date of Birth must be in MM/DD/YYYY format.

Date of Birth must not be a future date.

Date of Birth must not be before 1900.

Sorry, you must be 18 years or older to participate.

Card number must be 9 digits long.

You have already requested a replacement card today. Please try again tomorrow if you need another replacement card.

The card number you entered is not valid. If you need assistance, please call 1-855-326-1404.

The information provided did not retrieve any record. Please verify the information you entered and try again.

Please enter a valid card number and try again.

Eligibility Restrictions

TO THE PATIENT:

The Momentum Savings Card is not valid for patients whose prescription claims are reimbursed, in whole or in part, by any state or federal government program, including, but not limited to, Medicaid, Medicare, Medigap, Department of Defense (DoD), Veterans Affairs (VA), TRICARE, CHAMPUS, Puerto Rico Government Health Insurance, or any State Patient or Pharmaceutical Assistance Program. This offer is void where prohibited by law. Certain rules and restrictions apply.

PLEASE NOTE:

If you are not eligible for the Momentum Savings Card, you may still enroll in the program to receive tips, suggestions, helpful advice, recipes and other useful information.

If you need assistance with the Momentum Program, please call 1-855-326-1404. An agent is available to assist you from 8 AM to 8 PM ET, Monday through Friday.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.