For more information, please go to www.XIMINORX.com.

Terms and Conditions:
Eligible commercially insured patients may pay as little as $25/month for three fills of an XIMINO prescription, subject to a maximum program benefit per fill. Eligible commercially insured and not covered patients may pay as little as $75/month for three fills of an XIMINO prescription, subject to a maximum program benefit per fill. After the program maximum, you will be responsible for the difference. This offer is valid only for those with commercial insurance and who have a valid prescription. This offer is not valid under Medicare, Medicaid, or any other federal or state program, for cash-paying patients, or where a plan reimburses you for the entire cost of your prescription drug. This offer is not transferrable, and cannot be combined with any other offer. This offer is not health insurance and is only valid for patients in the 50 United States, Washington DC, and Puerto Rico. Void where prohibited or restricted. Additional terms and conditions may apply. This offer may change at any time, without notice. When you use this card, you are certifying that you understand the program rules, regulations and these Terms and Conditions, that you have responded truthfully to questions when activating the card, and that you will disclose and report the use of this offer as may be required by your insurer. It is illegal to sell, purchase, trade, counterfeit, duplicate, or reproduce, or offer to sell, purchase, trade, counterfeit, duplicate, or reproduce the card. This card must be presented to the pharmacist with a valid prescription to participate in this program. If you have any questions regarding your eligibility or benefits, or if you wish to discontinue your participation, call the XIMINO Savings program at 1-888-XIMINO-4 (1-888-946-4664) (8:00 am-8:00 pm EST, Monday-Friday). Sun Pharma reserves the right to modify or discontinue this offer at any time without notice.

 

XIMINO™ (minocycline hydrochloride) extended release Copay Card Activation

Welcome to the XIMINO Copay Card Program activation site. Please provide the following information to activate your copay card and begin saving.

Card ID
First Name* Last Name*
Address - Line 1 Address - Line 2
City State Zip Code*
Date of Birth* Patient's 10‑Digit Phone Number*
E-mail Address Preferred Method of Contact:
Are your prescriptions paid for in part or full under any state or federally funded program? Such programs include, but are not limited to, Medicare or Medicaid, Medigap, VA, DOD, or TriCare.*

Do you have commercial insurance that covers your prescriptions?*

You understand that the personal information you provide and information pertaining to the use of your copay card at the pharmacy will be shared with Sun Pharma, and its third party partners. Sun Pharma and companies providing services to Sun Pharma will not sell or rent your personally identifiable information, as described in the Privacy Policy, which you can view by visiting www.sunpharma.com/privacy-policy .
Do you agree to these statements?*

You agree to be contacted at the phone number, address or email provided to receive information about products, services and promotional offers from Sun Dermatology. You understand that you have the ability to opt-out of these by calling 1-888-XIMINO-4 or clicking on the link contained in email.
Do you agree to these statements?*

*Field is required.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.