Program Terms, Conditions, and Eligibility Criteria:
This offer is good for use only with a valid prescription for
Lo Loestrin® Fe (norethindrone acetate and ethinyl
estradiol tablets, ethinyl estradiol tablets and ferrous fumarate tablets)
at the time the prescription is filled by the pharmacist and dispensed to
Depending on your insurance coverage, most eligible patients pay no more than $25
for each of up to nine (9) one-month prescription fills OR pay no more than $35
for each of up to three (3) three-month prescription fills. Check with your
pharmacist for your copay discount. Maximum savings limit applies; patient
out-of-pocket expense may vary.
This offer is not valid for use by patients enrolled in Medicare, Medicaid, or other
federal or state programs (including any state 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 offer if they are Medicare-eligible and
enrolled in an employer-sponsored health plan or prescription drug benefit program for
retirees. This offer is not valid for cash-paying patients.
Each card is valid for up to nine (9) prescription fills of a 28-day supply
each OR up to three (3) prescription fills of an 84-day supply each. Offer
applies only to prescriptions filled before the program expires on 6/30/17.
Allergan reserves the right to rescind, revoke, or amend this offer without notice.
Offer good only in the USA, including Puerto Rico, at participating retail pharmacies.
Void if prohibited by law, taxed, or restricted.
This card is not transferable. The selling, purchasing, trading, or counterfeiting
of this card is prohibited by law.
This card has no cash value and may not be used in combination with any other discount,
coupon, rebate, free trial, or similar offer for the specified prescription.
This offer is not health insurance.
This card expires June 30, 2017.
By redeeming this card, you acknowledge that you are an eligible patient and that
you understand and agree to comply with the terms and conditions of this offer.
For questions about the program, including savings on mail-order prescriptions,
please call 1.855.439.2817.