Important Safety Information
* = Required Fields
This SAVINGS card can be used to reduce the amount of your out-of-pocket expense up to a maximum of $25 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, 2018, with a benefit cap of $300 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 Elestrin) 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 Elestrin 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 Pharmaceutical Inc. 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 Pharmaceutical Inc. for market research and other purposes related to assessing coupon programs. Data shared with Mylan Pharmaceutical Inc. 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 Elestrin 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.
These are not all the possible side effects of ELESTRIN. For more information, ask your healthcare provider or pharmacist for advice about side effects.Important things to remember when using ELESTRIN
Wash your hands with soap and water after applying the gel to reduce the chance that the medicine will be spread from your hands to other people. Allow the gel to dry for five minutes or more before dressing. Try to keep the area dry for as long as possible. Do not allow others to come in contact with the area of skin where you applied the gel for at least two hours after you apply ELESTRIN. Do not apply sunscreen to the area where the gel was applied for at least 25 minutes or for 7 or more consecutive days.Never apply ELESTRIN to the breast. Never apply ELESTRIN in or around the vagina. Do not allow others to apply the gel for you. Avoid fire, flame or smoking until the gel has dried. ELESTRIN contains alcohol.
Alcohol based gels are flammable. It is important that you read and follow the detailed "Patient Instructions for Use" on how to use the ELESTRIN pump and apply the dose.
Keep ELESTRIN out of the reach of children.
ELESTRIN (estradiol gel) is used after menopause to reduce moderate to severe hot flashes.
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.