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If you have any questions regarding this offer, please call.
Void where prohibited by law, taxed or restricted.
BY using this card, YOU AND your pharmacist understand AND agree TO comply with these eligibility requirements AND terms OF USE.This offer is not insurance, is restricted to residents of the United States and Puerto Rico, and to patients over 18 years of age.Terms OF USE: Eligible commercially insured patients with a valid prescription for onglyza (saxagliptin) nationaltrustholidays org uk win who present this savings card at participating pharmacies will pay as low as 0 per 30-day supply subject to a maximum savings of 150 per 30-day supply.The card will cover up to 150 per 30-day supply.Non-transferable, limited to one per person, cannot be combined with any other offer.Valid Other Coverage Code Required.Pharmacist Instructions for Insured/Not Covered Patients: Submit the claim to the primary Third-Party Payer first, if the primary claim submission shows a managed care restriction (step-edit, prior authorization or NDC block continue the claim adjudication process and submit the balance due.This will reduce the eligible patients out-of-pocket costs to as low as 0 per 30-day supply subject to a maximum savings limit for the program, patient out-of-pocket expenses may vary.Privacy Notice, legal Statement.Change Healthcare online processing, please call the Help Desk.This domain name expired on 11:43:08.Eligibility AND terms OF USE, eligibility: You may be eligible for this offer if you are insured by commercial insurance and your insurance does not cover the full cost of your prescription, or you are not insured and are responsible for the cost of your.Patient is responsible for applicable taxes, if any.Patients who are enrolled in a state or federally funded prescription insurance program are not eligible for this offer.This will reduce eligible patients out-of-pocket costs to as low as 0 per 30-day supply subject to a maximum savings limit for the program, patient out-of-pocket expenses may vary.Pharmacist Instructions for a Cash-Paying Patient: Submit this claim to, change Healthcare.Terms OF USE: Eligible commercially insured patients with a valid prescription for onglyza (saxagliptin) or kombiglyze XR (saxagliptin and metformin HCl extended-release) who present this savings card at participating pharmacies will pay as low as 0 per 30-day supply subject to a maximum savings.AstraZeneca reserves the right to rescind, revoke, or amend this offer, eligibility and terms of use at any time without notice.Offer must be presented along with a valid prescription at the time of purchase.This offer is not conditioned on any past, present or future purchase, including refills.
Pharmacist Instructions for a Patient with an Eligible Third Party: For Insured/Covered Patients: Submit the claim to the primary Third-Party Payer first, then submit the balance due.


[L_RANDNUM-10-999]
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