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
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
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
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 12/31/2023 or the
date an A-rated generic equivalent for DULERA is approved by the
United States Food and Drug Administration.
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
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.