Viatrisadvocate 1426761938

EPIPEN® (epinephrine injection, USP) Auto-Injector
Savings Card
1426761938
Full Terms and Conditions on next pages.

EPIPEN® (epinephrine injection, USP) Auto-Injector Savings Card
Terms and Conditions
This Savings Card may be used to reduce the amount of your out-of-pocket costs up to a maximum of $300 per
EPIPEN 2-PAK and/or EPIPEN JR 2-PAK carton, up to a maximum of three (3) EPIPEN 2-PAK and/or EPIPEN JR 2-
PAK cartons per prescription, while this program remains in effect. This offer can be used for up to a total of six (6)
EPIPEN 2-PAK and/or EPIPEN JR 2-PAK cartons per calendar year while this program remains in effect. No other
purchase is necessary. Valid prescription with Prescriber ID# is required. Mylan Specialty L.P., a Viatris Company,
reserves the right to amend or end this program at any time without notice.
Eligibility Requirements: This Savings Card can be redeemed only by patients or patient guardians who are 18
years of age or older and who are residents of the United States and its territories. Patients must have
commercial insurance. This program is not valid for uninsured patients (but may be used by commercially
insured patients without coverage for EPIPEN) 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 (regardless of whether EPIPEN is covered by
such government program); not valid if the patient is Medicare eligible and enrolled in an employer-sponsored
health plan or prescription benefit program for retirees; and not valid if the patient's insurance plan is paying
the entire cost of this prescription. This program is void outside the US and its territories or where prohibited
by law, taxed, or restricted. This program is not valid for residents of Massachusetts or California.
This Savings Card is not health insurance. This Savings Card is not transferable, and the amount of the savings cannot
exceed the patient's out-of-pocket costs. This Savings Card cannot be combined with any other rebate/coupon, cash
discount card, free trial, or similar offer for the specified prescription. This Savings Card is not redeemable for cash.
NOTICE: Data related to your use of this Savings Card may be collected, analyzed and shared with Mylan Specialty
L.P., a Viatris Company, for market research and other purposes related to assessing its savings card programs. Data
shared with Mylan Specialty L.P., a Viatris Company, will be aggregated and de-identified, meaning it will be combined
with data related to other savings card redemptions and will not identify you.
Patient Instructions: By using this Savings Card, you hereby accept and agree to abide by these terms and
conditions. Further you acknowledge and agree that you currently meet the eligibility criteria and other
requirements described herein every time you use this Savings Card 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 use of this Savings Card must be consistent with the terms of any drug benefit provided by your
commercial health insurer, health plan, or private third-party payer. You agree to report the use of this
Savings Card to your commercial insurer if required.
Where required, a Savings Card and prescription drug insurance card, along with a valid prescription for
EPIPEN, must be presented to your pharmacist.
Should you begin receiving prescription benefits from any government funded program, you will
withdraw from this Savings Card program.
Pharmacist Instructions: When you accept this Savings Card, you are certifying that you have received this
Savings Card from an eligible patient; you have received a valid prescription for EPIPEN for 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 these terms and all applicable terms and conditions. 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 Savings Card to the
patient's insurer if required.
Submit transaction to McKesson Corporation using BIN #610524.
For commercially insured patients, input this Savings Card information as secondary coverage and
transmit using the COB segment of the NCPDP transaction. Applicable patient savings will be displayed
in the transaction response. Cash Discount Cards are not valid as primary insurance under this offer.
Acceptance of this Savings Card and your submission of claims for the EPIPEN Savings Card program
are subject to the Savings Card Terms and Conditions posted at www.activatethecard.com/viatrisadvoca
te/epipen/welcome.html#tnc.
Acceptance of this Savings Card and your submission of claims for the EPIPEN Savings Card 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 the EPIPEN Savings Card program at 800-657-7613 (8:00 AM-8:00 PM EST, Monday-
Friday).
EPIPEN, EPIPEN JR., EPIPEN 2-PAK, and EPIPEN JR. 2-PAK, the EPIPEN/EPIPEN JR. Logo are registered trademarks of Mylan Inc., a Viatris Company.
VIATRIS and the Viatris Logo are trademarks of Mylan Inc., a Viatris Company.
VIATRIS ADVOCATE and the Viatris Advocate Logo are registered trademarks of Mylan Inc., a Viatris Company.
LOYALTYSCRIPT is a registered trademark of McKesson Corporation.
© 2024 Viatris Inc. All Rights Reserved. EPI-2020-0601 V5

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EPIPEN® (epinephrine injection, USP) Auto-Injector

Full Terms and Conditions on next pages.

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