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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.
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 DULERA (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 DULERA 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 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 (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.
- Benefits for this Program reset each calendar year. Re-enrollment in this Program is required at regular intervals. You may continue in this Program if you re-enroll as required by Organon and you continue to meet all the Program's then-current eligibility requirements.
- Coupon will not be valid for use if an A-rated generic equivalent is approved by the United States Food and Drug Administration.
- ORGANON RESERVES THE RIGHT TO RESCIND, REVOKE, OR AMEND THIS PROGRAM AT ANY TIME WITHOUT NOTICE.
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.