This program is only available to residents of the United States and US territories, where specified. Most commercially insured and eligible uninsured patients are eligible. This offer is not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare, TRICARE, the Veterans Administration, the Puerto Rico Government Health Insurance Plan or any other federal or state healthcare programs. If your insurance changes, you may no longer be eligible to use this coupon. Coupons can only be processed
exclusively at participating pharmacies.
To activate your coupon, please answer the following questions:
Eligibility Criteria/Terms and Conditions:
By using the coupon, you confirm that you understand and agree to
comply with the following terms and conditions of this offer:
This offer is only valid for eligible patients with commercial
insurance and eligible uninsured patients.
This offer is not valid for any person eligible for
reimbursement of prescriptions, in whole or in part, by any
federal, state, or other governmental programs, including, but
not limited to, Medicare (including Medicare Advantage and Part
A, B, and D plans), Medicaid, TRICARE, Veterans Administration
or Department of Defense health coverage, CHAMPUS, the Puerto
Rico Government Health Insurance Plan, or any other federal or
state health care programs.
You agree not to seek reimbursement for all or any part of the
benefit received through this offer and are responsible for
making any required reports of your use of this offer to any
insurer or other third party who pays any part of the
prescription filled.
This offer is good only in the United States of America
(including the District of Columbia, Puerto Rico, Guam and the
U.S. Virgin Islands) at retail pharmacies. This offer is not
valid where otherwise prohibited, taxed, or otherwise
restricted.
You must be 18 years of age or older to redeem this offer for
yourself or a minor.
You must present this coupon along with your prescription to
participate in this program.
This coupon is good for use only with the products identified
herein. No other purchase is necessary.
This offer cannot be redeemed at government-subsidized clinics.
Reimbursement limitations may apply based on patient‘s
individual insurance plan rules and patient‘s deductible;
therefore, patient‘s out-of-pocket expense may vary. Patient is
responsible for all additional costs and expenses after
reimbursement limits are reached.
This coupon and offer are not health insurance.
The selling, purchasing, trading, or counterfeiting of this
coupon is prohibited by law. Void if reproduced.
This offer is not valid with other offers. This coupon has no
cash value. No cash back.
Sprout Pharmaceuticals reserves the right to rescind, revoke,
terminate, or amend this offer at any time, without notice.
You understand and agree to comply with the terms and conditions
of this offer as set forth above at
www.activatethecard.com/sprout/addyi.