Terms & Conditions:
Patient Instructions: EYLEA must be covered by your commercial insurance. Not valid for cash paying customers. This offer is not valid for prescriptions covered by or submitted for reimbursement under Medicaid, Medicare, VA, DOD, TRICARE, or similar federal or state programs including any state pharmaceutical assistance program. This program is not valid where prohibited by law. By redeeming this coupon, you are certifying that (1) you are not a beneficiary of any government funded program as noted above; (2) should you begin receiving prescription benefits from any government funded program, you will withdraw from this program; and (3) you acknowledge and understand that adherence to the terms and conditions of this offer is necessary to ensure compliance with laws pertaining to any government funded program. In addition, you are certifying that (i) the use of the copay card is not inconsistent with the terms of your arrangement with your insurer or other third-party payer and (ii) you will comply with any obligations to disclose the use of the copay card to any applicable payer. For questions regarding your eligibility or benefits or if you wish to discontinue your participation, please call 1-888-335-3264.
IMPORTANT NOTICE: This program is not valid for prescriptions eligible to be reimbursed, in whole or in part, by Medicaid, Medicare (including Medicare Part D), or other federal or state programs (including any state prescription drug assistance programs). No claim for reimbursement of the out-of-pocket copay amount covered by this program may be submitted to any third-party payer, whether public or private. This program cannot be combined with any other rebate/coupon, free trial, or similar offer. This program is not transferable, and is good only in the United States, its territories and possessions. This program is subject to certain eligibility requirements. Regeneron reserves the right to rescind, revoke, or amend this program without notice. By using this program, you understand and agree to comply with the terms and conditions set forth above.