With the $0 co-pay card, you could be eligible to save on up to three EpiPen 2-Pak® or EpiPen Jr 2-Pak® cartons (with a maximum benefit of up to $100 per EpiPen 2-Pak®) every time you fill your prescription, now through December 31, 2015.
This offer may not be combined with any other EpiPen® coupon or savings offer. See below for Terms and Conditions. Certain eligibility restrictions apply.
Please fill out the following form to see if you are eligible. If you are, you will be able to print your $0 co-pay card right away. Download Now>>
This CO-PAY card can be used to reduce the amount of your out-of-pocket expense up to a maximum of $100 per two-pack of EpiPen® Auto-Injector cartons, up to a maximum of 3 two packs per prescription. No other purchase is necessary. This offer can be used an unlimited number of times until 12/31/2015. Valid prescription with Prescriber ID# required.
Eligibility Requirements: This CO-PAY card can be redeemed only by patients or patient guardians who are 18 years of age or older who are a resident of the United States. Not valid for cash paying patients (except for privately insured patients without coverage for EpiPen® Auto-Injector who make full cash payment) and patients who are covered by any state or federally funded healthcare program, including but not limited to any state pharmaceutical assistance program, Medicare (Part D or otherwise), Medicaid, Medigap, VA or DOD, or TriCare; if the patient is Medicare eligible and enrolled in an employer-sponsored health plan or prescription benefit program for retirees; or if the patient’s insurance plan is paying the entire cost of this prescription. Void outside the US and its territories or where prohibited by law, taxed, or restricted.
This CO-PAY card is not health insurance. The CO-PAY card is not transferable and the amount of the benefit cannot exceed the patient’s out-of-pocket expenses. Cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription. Mylan Specialty reserves the right to amend or end this program at any time without notice. Data related to your redemption with this CO-PAY card may be collected, analyzed, and shared with Mylan Specialty for market research and other purposes related to assessing coupon programs. Data shared with Mylan Specialty will be aggregated and de-identified, meaning it will be combined with data related to other EpiPen® CO-PAY card redemptions and will not identify you. The CO-PAY card is not redeemable for cash.
Patient Instructions:Present your CO-PAY card and prescription drug insurance card, along with a valid prescription for the EpiPen 2-Pak® or EpiPen Jr 2-Pak®. By using the EpiPen® CO-PAY card, you acknowledge that you currently meet the eligibility criteria and that you understand and will comply with the following additional terms and conditions:
- You have not submitted and will not submit a claim for reimbursement under any federal, state, or other governmental programs for this prescription.
- Your acceptance of this offer must be consistent with the terms of any drug benefit provided by your health insurer. You agree to report the use of this CO-PAY card to your insurer if required.
Pharmacist Instructions: When you use this CO-PAY card, you are certifying that you have received this CO-PAY card from an eligible patient; you have dispensed the product as indicated; you have not submitted and will not submit a claim for reimbursement under any federal, state, or other governmental programs for this prescription; and you will otherwise comply with the terms hereof. You further certify that your participation in this program is consistent with all applicable state laws and any obligations, contractual or otherwise, that you have as a pharmacy provider, and that you will report the use of this CO-PAY card to the patient’s insurer if required.
- Submit transaction to McKesson Corporation using BIN #610524
- Primary coverage must exist. Input CO-PAY card information as secondary coverage and transmit using the COB segment of the NCPDP transaction. Applicable discounts will be displayed in the transaction response.
- Acceptance of this CO-PAY card and your submission of claims for the EpiPen® program are subject to the Mylan CO-PAY card Terms and Conditions posted www.epipen.com/copay-offer.
- Acceptance of this CO-PAY card and your submission of claims for the EpiPen® program are subject to the LoyaltyScript® program Terms and Conditions posted at www.mckesson.com/mprstnc.
- For questions regarding setup, claim transmission, patient eligibility or other issues, call the LoyaltyScript® for EpiPen® program at 800-657-7613 (8:00 AM-8:00 PM EST, Monday-Friday).