MULTIUSE SAVINGS COUPON

Eligible privately insured patients may save up to $100 off their out‑of‑pocket cost, on each of up to 3 qualifying prescriptions for Ganirelix Acetate Injection.

The coupon is not insurance.

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



If eligible, follow these steps to save up to $100 off on each of up to 3 qualifying prescriptions for Ganirelix Acetate Injection:

  • If your doctor thinks that Ganirelix Acetate Injection is right for you, he or she will write a prescription for Ganirelix Acetate Injection.
  • The coupon can be used up to 3 times before the expiration date and provides a maximum benefit of up to $100 or the amount of your out‑of‑pocket cost, whichever is less, off on each of up to 3 qualifying prescriptions (regardless of the quantity supplied on the prescription).
  • 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 ganirelix.com to obtain a replacement coupon. Regardless of the number of replacement coupons received, the coupon offer is limited to 3 prescriptions for Ganirelix Acetate Injection per patient before the expiration date.
  • Not all patients are eligible to use the coupon. Please see Coupon Terms and Conditions.

Coupon Terms and Conditions:

  • The coupon is valid for up to $100 off your out‑of‑pocket cost, on each of up to 3 qualifying prescriptions for Ganirelix Acetate Injection (regardless of the quantity supplied on the prescription).
  • Limit 1 use per patient per 21 days.
  • Coupon is valid for use 3 times only. Patient must have a co‑payment for the prescription. Savings are limited to amount of your out‑of‑pocket cost, up to a maximum of $100 per prescription for up to 3 qualifying prescriptions.
  • 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, 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").
  • The coupon is not valid for patients covered under any qualified health plan purchased through a health insurance exchange (marketplace) established by a state government or the federal government ("Exchange Plan").
  • Not valid for residents of Massachusetts if an A‑rated generic equivalent for Ganirelix Acetate Injection is approved by the United States Food and Drug Administration.
  • 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: the earlier of 06/30/2017 or the date an A-rated generic equivalent for Ganirelix Acetate Injection is approved by the United States Food and Drug Administration.