Terms and Conditions:
For patients whose BromSite® prescriptions are covered by commercial insurance, use of this card may reduce your copayment responsibility to as little as $35.
For patients whose BromSite® prescriptions are not covered by either commercial or government insurance, use of this card may reduce your cost for BromSite® to as little as $60.

This program is subject to overall maximum support amounts, and is valid for up to 3 prescriptions.

This coupon is not valid for Federal health care beneficiary prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare, Tricare or other federal or state healthcare programs (including any state prescription drug assistance programs).

Patients that have prescription drug coverage under Medicare Part D may take advantage of this offer, provided that they acknowledge that by doing so they will not seek any prescription coverage or reimbursement from their insurer for the cost of BromSite®, or report any amounts paid for BromSite® as part of their "true out of pocket expenses" under Medicare Part D.



To the Patient:
You must activate and present this card to the pharmacist with a valid prescription to participate in this program. If you have questions regarding your eligibility or benefits, or if you wish to discontinue your participation, call the Sun Pharma BromSite® Copay Card Activation program at 1.855.379.2324 (8:00 am-8:00 pm EST, Monday-Friday). For patients whose BromSite® prescriptions are covered by commercial insurance, use of this card may reduce your copayment responsibility to as little as $35. For patients whose BromSite® prescriptions are not covered by either commercial or government insurance, use of this card may reduce your cost for BromSite® to as little as $60. This program is subject to overall maximum support amounts, and is valid for up to 3 prescriptions. This coupon is not valid for Federal health care beneficiary prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare, Tricare or other federal or state healthcare programs (including any state prescription drug assistance programs). Patients that have prescription drug coverage under Medicare Part D may take advantage of this offer, provided that they acknowledge that by doing so they will not seek any prescription coverage or reimbursement from their insurer for the cost of BromSite®, or report any amounts paid for BromSite® as part of their "true out of pocket expenses" under Medicare Part D. When you use this card, you are certifying that you understand the program rules, regulations and terms and conditions, and that you have responded truthfully to questions when activating the card. This offer expires on 3/31/20.

To the Pharmacist: When you process this card, you are certifying that you have read, understood, and are in compliance with the terms and conditions pertaining to this program. You are further certifying that you have not submitted and will not submit a claim for reimbursement under Medicare Part D or similar federal or state programs including any state medical pharmaceutical assistance program for this prescription.

  • Submit transaction to McKesson Corporation using BIN #610524
  • If primary commercial prescription insurance exists, input card information as secondary coverage and transmit using the COB segment of the NCPDP transaction. Applicable discounts will be displayed in the transaction response.
  • Acceptance of this card and your submission of claims for the Sun Pharma BromSite® Copay Card Activation program are subject to the LoyaltyScript® program Terms and Conditions posted at www.mckesson.com/mprstnc
  • Sun Pharma reserves the right to rescind, revoke, or change this offer at any time. The LoyaltyScript® card is not valid for use with any other prescription drug discount or cash cards for BromSite®. Claims submitted utilizing the program are subject to audit or validation.
  • For questions regarding setup, claim transmission, patient eligibility or other issues, call the LoyaltyScript® for Sun Pharma BromSite® Copay Card Activation program at 1.855.379.2324 (8:00 am-8:00 pm EST, Monday-Friday).
    Sun Pharma reserves the right to rescind, revoke or amend this offer at any time.