ELIQUIS Co-pay Card

ELIGIBILITY REQUIREMENTS:

You may be eligible for the Co-pay Card for ELIQUIS^® (apixaban) if:

1. 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;
2. 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;
3. You are 18 years of age or older; and
4. You are a resident of the United States or Puerto Rico.

TERMS OF USE:

1. Eligible patients who present an activated Co-pay Card together with a valid prescription for ELIQUIS at participating pharmacies can pay no more than $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.
2. Offer not applicable to co-pays of $10 or less.
3. 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.
4. 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.
5. Card must be activated before use. Activation and first use of the Co-pay Card must take place by December 31, 2019. 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 June 30, 2019.
6. All Program payments are for the benefit of the patient only.
7. Only valid in the United States and Puerto Rico; this offer is void where restricted or prohibited by law.
8. 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.
9. The Co-pay Card may not be sold, purchased, traded, or counterfeited. Reproductions of this Co-pay Card are void.
10. Bristol-Myers Squibb and Pfizer reserve the right to rescind, revoke, or amend this offer at any time without notice.
11. This offer is not conditioned on any past, present, or future purchase, including refills.
12. No membership fees.
13. 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 non-participating 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:

PO 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.

To the pharmacist: For processing assistance, please call McKesson Pharmacy Support at 1-866-279-4730.

Please see Full Prescribing Information, including Boxed WARNINGS and Medication Guide.