Notice to Qualified Health Plans:

After careful consideration and deliberation, including analysis of the October 30, 2013, and February 6, 2014, letters from former Secretary Sebelius to Representative McDermott (D-WA) and Senator Grassley (R-IA), respectively, Merck has decided to make a co-payment assistance program for this Product available to enrollees of a health insurance exchange established by a state government or the federal government who are not eligible for Medicaid. The terms and conditions of our patient co-payment assistance program are set forth below.

MULTIUSE SAVINGS COUPON

Eligible privately insured patients may pay as little as $5 per qualifying prescription of ZEPATIER. The maximum benefit is 25% of the catalog price of ZEPATIER (as set by the manufacturer at the time of purchase) per prescription.

The coupon is not insurance.

ZEPATIER is a prescription medication. Only your health care provider can decide whether ZEPATIER is right for you.

If eligible, follow these steps to save on each qualifying prescription of ZEPATIER:

  • If your doctor thinks that ZEPATIER is right for you, he or she will write a prescription for ZEPATIER.
  • Patient must pay the first $5 on each prescription (up to 28 tablets per prescription). Savings are limited to the amount of the patient's actual out-of-pocket cost over $5 on each qualifying prescription, up to a maximum benefit of 25% of the catalog price of ZEPATIER (as set by the manufacturer at the time of purchase) per prescription. Coupon savings may not exceed the patient's actual out-of-pocket cost. Coupon may be redeemed on qualifying prescriptions (up to 28 tablets per prescription) for up to 112 tablets of ZEPATIER in total prior to the coupon expiration date.
  • Review the Terms and Conditions below and then click on the "Activate & Print a New Coupon" button below and follow the activation instructions.
  • Print the coupon.
  • Present the activated coupon and your insurance card with a valid signed prescription at any participating eligible retail or mail-order pharmacy (certain restrictions apply).
  • If you are unable to redeem the coupon at your eligible retail or mail-order pharmacy, please keep your receipt and call McKesson Corporation at 877-264-2454 within 30 days of purchase to request a Direct Member Reimbursement (DMR) form. Please note: Not all patients will be eligible for Direct Member Reimbursement. Merck may discontinue Direct Member Reimbursement at any time without notice.
  • If you lose the coupon, please visit zepatier.com to obtain a replacement coupon. Regardless of the number of replacement coupons received, the coupon offer is limited to savings on qualifying prescriptions for up to 112 tablets of ZEPATIER in total before the expiration date.
  • Not all patients are eligible to use the coupon. Please see Coupon Terms and Conditions.

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 to save on your out-of-pocket costs on qualifying prescriptions (up to 28 tablets per prescription) for up to 112 tablets of ZEPATIER in total before the expiration date printed on the coupon.


Coupon Terms and Conditions:

  • The coupon is valid for up to 28 tablets per prescription. Patient must have a co-payment (or, if privately insured without coverage for ZEPATIER, make full cash payment) for the prescription. Savings are limited to the amount of patient's out-of-pocket cost over $5 per qualifying prescription, up to a maximum benefit of 25% of the catalog price of ZEPATIER (as set by the manufacturer at the time of purchase) per prescription. Coupon savings may not exceed the patient's actual out-of-pocket cost.
  • Coupon may be redeemed on qualifying prescriptions (up to 28 tablets per prescription) for up to 112 tablets of ZEPATIER in total.
  • No other purchase is necessary.
  • The coupon is not transferable. No substitutions are permitted. The offer cannot be combined with any other coupon, free trial, discount, prescription savings card, or other offer.
  • The coupon is not insurance.
  • Patient must have private insurance. Not valid for uninsured patients or patients covered under Medicaid (including Medicaid patients enrolled in a qualified health plan purchased through a health insurance exchange [marketplace] established by a state government or the federal government), Medicare, a Medicare Part D or Medicare Advantage plan (regardless of whether a specific prescription is covered), TRICARE, CHAMPUS, Puerto Rico Government Health Insurance Plan ("Healthcare Reform"), or any other state or federal medical or pharmaceutical benefit program or pharmaceutical assistance program (collectively, "Government Programs").
  • You must be 18 years of age or older to redeem the coupon. Patient, pharmacist, and prescriber agree not to seek reimbursement for all or any part of the benefit received by the patient through the offer. Patient is 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 coupon, as may be required.
  • The coupon can be used only by eligible residents of the United States or the Commonwealth of Puerto Rico at participating eligible retail or mail-order pharmacies in the United States or the Commonwealth of Puerto Rico. Product must originate in the United States or the Commonwealth of Puerto Rico.
  • The coupon is the property of Merck and must be turned in on request.
  • It is illegal to sell, purchase, trade, or counterfeit, or offer to sell, purchase, trade, or counterfeit the coupon. Void if reproduced. Void where prohibited by law, taxed, or restricted.
  • Merck reserves the right to rescind, revoke, or amend the offer at any time without notice.
  • Data related to your redemption of the coupon may be collected, analyzed, and shared with Merck, for market research and other purposes related to assessing coupon programs. Data shared with Merck will be aggregated and de-identified, meaning it will be combined with data related to other coupon redemptions and will not identify you.
  • Expiration Date: 06/30/2017.