Eligible privately insured patients may pay as little as $15 per prescription on each of up to 12 qualifying prescriptions. Maximum savings is $90 per prescription.
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, Organon 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.
STEP 1: Select the appropriate option:
STEP 2: Review and accept the Terms and Conditions of the coupon:
- The coupon is valid for up to $90 off your out-of-pocket cost on each of up to 12 qualifying prescriptions for ASMANEX HFA or ASMANEX TWISTHALER (regardless of the quantity supplied on the prescription). Patient is responsible for the first $15 of their out-of-pocket cost.
- The coupon is valid for use 12 times only. Patient must have a co-payment (or, if privately insured without coverage for ASMANEX HFA or
ASMANEX TWISTHALER, make full cash payment) for the prescription. Savings are limited to amount of your out-of-pocket cost over $15, up to a maximum of $90 per prescription for up to 12 qualifying prescriptions. - The coupon may be redeemed only once every 30 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").
- Subject to changes in state law, this coupon may become invalid for residents of Massachusetts prior to its expiration date.
- 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 Organon 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.
- Organon 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 Organon, for market research and other purposes related to assessing coupon programs. Data shared with Organon 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 12/31/2022 or the date an A-rated generic equivalent for ASMANEX HFA or ASMANEX TWISTHALER is approved by the United States Food and Drug Administration. For clarity, if an A-rated generic equivalent to ASMANEX HFA is approved by the FDA before 12/31/2022, by way of example only, this coupon will no longer be valid for ASMANEX HFA as of that date, but will remain valid for ASMANEX TWISTHALER until its expiration date, provided all other eligibility restrictions and terms and conditions are met.
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.