Eliquis® (apixaban) 360 Support Free 30-Day Trial and Co-pay Eligibility Terms And Conditions
$10 Co-pay Eligibility and Terms of Use
ELIGIBILITY REQUIREMENTS:
You may be eligible for the Co-pay Card for ELIQUIS® (apixaban) if:
- You are insured by commercial insurance and your prescription insurance coverage does not cover the full cost of your prescription, that is, you have a co-pay obligation for ELIQUIS;
- You do not have prescription insurance coverage through a state or federal healthcare program, including but not limited to Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), or Department of Defense (DOD) programs; patients who move from commercial plans to state or federal healthcare programs will no longer be eligible;
- You are 18 years of age, or older; and
- You are a resident of the United States or Puerto Rico.
TERMS OF USE:
- Eligible patients who present an activated Co-pay Card together with a valid prescription for ELIQUIS at participating pharmacies may pay as little as $10 per 30-day supply (up to 74 tablets for the first fill and up to 60 tablets for all subsequent fills) for up to 24 months, subject to a maximum annual benefit of $3800. Other restrictions may apply. Patient is responsible for applicable taxes, if any.
- Offer not applicable to co-pays of $10 or less.
- Patients, pharmacists, and prescribers cannot seek reimbursement, from health insurance or any third party, for any part of the benefit received by the patient through this offer.
- Your acceptance of this offer confirms that this offer is consistent with your insurance and that you will report the value received as may be required by your insurance provider.
- Card must be activated before use. Activation and first use of the Co-pay Card must take place by December 31, 2021. Card expires 24 months from activation. Upon expiration, eligible patients may re-enroll in the Co-pay Card Program. Absent a change in Massachusetts law, for Massachusetts residents only, this offer will expire on January 1, 2021.
- All Program payments are for the benefit of the patient only.
- Only valid in the United States and Puerto Rico; this offer is void where restricted or prohibited by law.
- This offer is non-transferable, no substitutions are permissible, and offer cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription.
- The Co-pay Card may not be sold, purchased, traded, or counterfeited. Reproductions of this Co-pay Card are void.
- Bristol-Myers Squibb and Pfizer reserve the right to rescind, revoke, or amend this offer at any time without notice.
- This offer is not conditioned on any past, present, or future purchase, including refills.
- No membership fees.
- The Co-pay Card for ELIQUIS is not health insurance.
The Co-pay Card will be accepted only at participating pharmacies. For those customers using mail-order or any nonparticipating retail pharmacy, please call 866-279-4730 to request a patient rebate form, or go to www.patientrebateonline.com to download a form.
Questions can also be submitted via mail to:
P.O. Box 2914
Phoenix, AZ 85062-2914
BY USING THIS CARD, YOU AND YOUR PHARMACIST UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.
Eliquis 30-Day FREE Trial Eligibility and Terms of Use
ELIGIBILITY REQUIREMENTS:
You may be eligible for the Free 30-Day Trial Offer for ELIQUIS® (apixaban) if:
- You have not previously filled a prescription for ELIQUIS;
- You have a valid 30-day prescription for ELIQUIS;
- You are being treated with ELIQUIS for an FDA-approved indication that an HCP has planned for more than 35 days of treatment;
- You are 18 years of age, or older; and
- You are a resident of the United States or Puerto Rico.
TERMS OF USE:
- Eligible patients who present a Free 30-Day Trial card together with a valid 30-day prescription for ELIQUIS at participating pharmacies can receive a free 30-day supply (up to 74 tablets) of ELIQUIS. Patient is responsible for applicable taxes, if any. This offer may not be redeemed on prescriptions written for longer than 30 days.
- This offer is limited to one use per patient per lifetime and is non-transferrable. By redeeming this offer, you certify that you have not previously filled a prescription for ELIQUIS.
- The Free 30-Day Trial for the specified prescription cannot be combined with any other rebate/coupon, free trial, or similar offer. No substitutions are permitted.
- Patients, pharmacists, and prescribers cannot seek reimbursement for the Free 30-Day Trial of ELIQUIS from health insurance or any third party, including state or federally funded programs.
- Patients may not count the Free 30-Day Trial of ELIQUIS as an expense incurred for purposes of determining out-of-pocket costs for any plan, including true out-of-pocket costs, ("TrOOP"), for purposes of calculating the out-of-pocket threshold for Medicare Part D plans.
- Activation and use of the Free 30-Day Trial card must take place by December 31, 2021. This card expires on December 31, 2021.
- Only valid in the United States and Puerto Rico; this offer is void where restricted or prohibited by law.
- Bristol-Myers Squibb and Pfizer reserve the right to rescind, revoke, or amend this offer at any time without notice.
- This Free 30-Day Trial card may not be sold, purchased, traded, or counterfeited. Reproductions of this card are void.
- This offer is not conditioned on any past, present, or future purchase, including refills.
- The ELIQUIS Free 30-Day Trial offer is not health insurance.
BY USING THIS CARD, YOU AND YOUR PHARMACIST UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

