STEP 2: Review and accept the Terms and Conditions of the coupon:
The coupon is valid for up to $300 off your out-of-pocket cost on each of up to 3 qualifying prescriptions for FOLLISTIM AQ Cartridge (regardless of the quantity supplied on the prescription).
The 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 $300 per prescription for up to 3 qualifying prescriptions.
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, 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 FOLLISTIM AQ Cartridge 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 12/31/2018 or the date an A-rated generic equivalent (or other therapeutically substitutable product) for FOLLISTIM AQ Cartridge 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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