Eligible patients can get either FARXIGA or XIGDUO XR for as low as $0 per month for as long as your doctor prescribes any available dose of either medication.
Request your Savings Card (or activate one you already have) by clicking on the appropriate link above. Complete the form on the Activation Page.
Retail customers: Present activated card with your prescription to your pharmacist.
Mail Order Customers: Call the number on the card and ask for Customer Service,
or click here for detailed instructions.
The Savings Card for Farxiga and Xigduo XR.
If your retail pharmacy or mail order pharmacy does not accept the Savings Card, follow these simple steps after activating your card:
Call your mail order pharmacy to see if they accept the Savings Card. If they do, provide them with your Savings Card ID number after they receive your prescription. You will receive your check when the pharmacy processes your prescription payment.
If they do NOT accept the Savings Card:
a. Call 1-866-355-9467 to request a patient rebate form, or go to www.patientrebateonline.com to download one.
b. When you receive your form, complete and sign it. Next, attach the original mail order receipt and return to the address listed on the form.
c. Remember to keep a copy of your receipts for your records. You should receive your check in about 3-4 weeks.
You will need to request/download a form each time you get a refill of your prescription and complete steps 2a and 2b to get your check.
FARXIGA and XIGDUO XR are trademarks of the AstraZeneca group of companies.
©2014 AstraZeneca. All rights reserved.
3044401 Last Updated 11/14
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