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By providing your email address above and by clicking SUBMIT below, you certify
that the information provided above is true and correct and that you
agree to receive information from Allergan related to
[Patient] Savings Program, including site updates, education, and other Allergan
products and services. The information pertaining to you that we collect will be
used in accordance with our Privacy Statement.
Your use of the Androderm® Savings Card constitutes acceptance of the
following Terms and Conditions:
The information pertaining to you that we collect will be used in accordance with our
Your personal information will not be shared with anyone.
I agree to receive marketing information, offers, refill reminders, and promotions
regarding men’s healthcare. I understand that the information that I provide will
unsubscribe, my consent will remain valid.
Offer not valid for prescriptions reimbursed in full, or in part, under Medicare,
Medicaid, TriCare, or any similar federal or state programs (including pharmaceutical
assistance programs), or private indemnity or HMO insurance plans that reimburse
you for the entire cost of your prescription drugs. Patients may not use this card
if they are Medicare-eligible and enrolled in an employer-sponsored health plan or
prescription drug benefit program for retirees. This is not insurance.
By using the offer, you agree that you will not submit a claim for the prescription
to a government payor. This offer is only valid in the United States. This offer is
void where prohibited by law. The card is not transferable and the amount of the
rebate cannot exceed the patient’s out-of-pocket expenses. If any part of your
prescription is paid for by a non-governmental third-party payor, you attest to
having disclosed this offer to your third-party payor. By using this offer, you are
consenting to the collection and use of certain personal information including your
phone number and elements of pharmacy claim information. This information will be
collected and used by service providers of Allergan, Inc. ("Allergan") in order to
administer this program. This information is not provided to Allergan directly. If
you do not consent, please do not use this offer. If you require additional
assistance, please call 1-855-285-8115.
Allergan reserves the right to rescind, revoke, or amend this offer without notice
at any time.