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

For eligible privately insured patients, Merck will help pay the out-of-pocket costs* for ISENTRESS, up to a maximum total program savings of $6,600. Coupon may be redeemed once every 21 days before the expiration date printed on the coupon.

*Out-of-pocket costs can include co-pay, deductible, and co-insurance.

The coupon is not insurance.

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

If eligible, follow these steps to save on qualifying prescriptions for ISENTRESS, up to a maximum total program savings of $6,600.

  • If your doctor thinks that ISENTRESS is right for you, he or she will write a prescription for ISENTRESS.
  • The coupon can be used once every 21 days before the expiration date. Savings are limited to the amount of your out‑of‑pocket cost on each prescription, up to a maximum total program savings of $6,600.
  • The coupon is limited to a 30-day supply of ISENTRESS per prescription fill. The coupon may be redeemed only once every 21 days.
  • 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 855‑396‑2623 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 isentress.com to obtain a replacement coupon. Regardless of the number of replacement coupons received, the coupon may be redeemed only once every 30 days 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 and receive savings on your out‑of‑pocket cost on an eligible prescription only once every 21 days before the expiration date printed on the coupon. Maximum program savings is $6,600.


Coupon Terms and Conditions:

  • The coupon provides savings on your out‑of‑pocket cost for ISENTRESS. Patient must have a co‑payment (or, if privately insured without coverage for ISENTRESS, make full cash payment) for the prescription. Savings are limited to the amount of your actual out‑of‑pocket cost, up to a maximum total program savings of $6,600.
  • The coupon is limited to a 30‑day supply of ISENTRESS per prescription fill. The coupon may be redeemed only once every 21 days.
  • 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 for yourself or a minor (other age restrictions may apply). Patient, guardian, pharmacist, and prescriber agree not to seek reimbursement for all or any part of the benefit received by the recipient through the offer. Patient or guardian 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: 03/31/2017.