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This SAVINGS card can be used to reduce the amount of your out-of-pocket expense up to a maximum of $100 after you pay the first $14 per 30 day prescription. No other purchase is necessary. This offer can be used up to a total of 12 times per calendar year through December 31, 2017, with a benefit cap of $1,200 per calendar year. Valid prescription with Prescriber ID# required.
Eligibility Requirements: This SAVINGS card can be redeemed only by patients or patient guardians who are 18 years of age or older and who are residents of the United States and its territories. Patients must have commercial insurance. Not valid for uninsured patients (but may be used by commercially insured patients without coverage for Dymista) and patients who are covered by any state or federally funded healthcare program, including but not limited to any state pharmaceutical assistance program, Medicare (Part D or otherwise), Medicaid, Medigap, VA or DOD, or TriCare (regardless of whether Dymista is covered by such government program); not valid if the patient is Medicare eligible and enrolled in an employer-sponsored health plan or prescription benefit program for retirees; and not valid if the patient's insurance plan is paying the entire cost of this prescription. Void outside the US and its territories or where prohibited by law, taxed, or restricted. This program is valid in Massachusetts through June 30, 2019, unless otherwise amended or extended by Massachusetts.
This SAVINGS card is not health insurance. The SAVINGS card is not transferable and the amount of the benefit cannot exceed the patient's out-of-pocket expenses. Cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription. This SAVINGS card is not redeemable for cash. Mylan Specialty reserves the right to amend or end this program at any time without notice.
NOTICE: Data related to your use of this SAVINGS card may be collected, analyzed and shared with Mylan Specialty for market research and other purposes related to assessing coupon programs. Data shared with Mylan Specialty will be aggregated and de-identified, meaning it will be combined with data related to other SAVINGS card redemptions and will not identify you.
Patient Instructions: Present your SAVINGS card and prescription drug insurance card, along with a valid prescription for the Dymista By using this SAVINGS card, you acknowledge that you currently meet the eligibility criteria and that you understand and will comply with the following additional terms and conditions:
Pharmacist Instructions: When you use this SAVINGS card, you are certifying that you have received this SAVINGS card from an eligible patient; you have dispensed the product as indicated; you have not submitted and will not submit a claim for reimbursement under any federal, state or other governmental programs for this prescription; and you will otherwise comply with these terms and all applicable terms and conditions. You further certify that your participation in this program is consistent with all applicable state laws and any obligations, contractual or otherwise, that you have as a pharmacy provider, and that you will report the use of this SAVINGS card to the patient’s insurer if required.
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. DYMISTA and other medicines may affect each other, causing side effects.
Before using DYMISTA tell your healthcare provider if you are pregnant or plan to become pregnant. It is not known if DYMISTA will harm your unborn baby.
DYMISTA is a prescription medicine used to treat symptoms of seasonal allergic rhinitis in people 6 years of age and older, who need treatment with both azelastine hydrochloride and fluticasone propionate. DYMISTA may help to reduce your nasal symptoms including stuffy nose, runny nose, itching, and sneezing.
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.
DYMISTA is a registered trademark of Meda Pharmaceuticals Inc., a Mylan company. The Mylan logo is a registered trademark of Mylan Inc. All other trademarks and service marks are the property of their respective owners.
© 2017 Mylan Specialty L.P. All rights reserved. 3/17 DYM-2017-0042