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Eligible privately insured patients may save up to $15 off their out‑of‑pocket cost on a qualifying prescription for PROVENTIL HFA.
Coupon may be redeemed once every 30 days before the expiration date printed on the coupon.
If your doctor prescribed PROVENTIL HFA and you are eligible, follow these simple steps to start saving:
STEP 2: Review and accept the Terms and Conditions of the coupon:
The coupon is valid for up to $15 off your out‑of‑pocket cost, on each qualifying prescription for PROVENTIL HFA (regardless of the quantity supplied on the prescription).
Coupon may be redeemed only once every 30 days before the expiration date. Patient must have a co-payment (or, if privately insured without coverage for PROVENTIL HFA make full cash payment) for
the prescription. Savings are limited to amount of your out-of-pocket cost, up to a maximum of $15 per qualifying prescription.
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 PROVENTIL HFA is approved by the United States Food and Drug Administration.
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: the earlier of 06/30/2017 or the date an A-rated generic equivalent for PROVENTIL HFA is approved by the United States Food and Drug Administration.
I have read and agree to the Terms and Conditions of the coupon. I want to proceed to activate the coupon.
STEP 3: Answer the activation questions regarding eligibility. You may be required to enter prescription insurance information, so please have the insurance card ready. Not all patients are eligible. Please see the Terms and Conditions above.
STEP 4: The activated coupon will be ready to use at an eligible pharmacy.
You must confirm that you have read and agree to the Terms and Conditions of the coupon.
You must select an option in Step 1 to proceed.
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