Eligibility Requirements

• ACTOS or ACTOS combination product coupons cannot be used if all or any part of your prescription is paid for by:
  • any federal or state healthcare program, including a state medical or pharmaceutical assistance program (Medicare, Medicaid, Tricare, etc),
  • Medicare Prescription Drug Program (Part D Program) or if you are currently in the coverage gap,
  • insurance that is paying the entire cost of the prescription, or
  • an insurer or other third-party payor in Massachusetts.

Terms and Conditions

• You must meet Eligibility Requirements.
• You agree to report your use of this coupon to any third party that reimburses you or pays for any part of the prescription price.
• You additionally agree that you will not submit the cost of any portion of the product dispensed pursuant to this coupon to a federal or state healthcare program for purposes of counting it toward your out of pocket expenses (such as TrOOP under Medicare Part D or Medicaid).
• The amount of this offer is not to exceed $50 or your co-pay amount, whichever is less.
• This coupon is not valid with any other program, discount, or incentive involving ACTOS.
• Offer is invalid for submissions postmarked later than eight weeks from the dispense date on the original receipt.
• This offer may be rescinded, revoked, or amended without notice.
• Valid for a minimum 30-day supply.
• Void where prohibited by law.

Save on prescriptions with the Together Rx Access^TM Program

• Together Rx Access is a prescription savings program that offers a free, easy way to save on prescription medications. Most cardholders save 20% to 40% on brand-name medicines and also save on a wide range of generic medications.^†
• To learn more about how to apply, eligibility requirements, and other information about the program, call 1-800-444-4106 or visit TogetherRxAccess.com.

†Each cardholder’s savings depend on such factors as the particular drug purchased, amount purchased, and pharmacy where purchased. Participating companies independently set the level of savings offered and the products included in the program. Those decisions are subject to change.

Patient Assistance Program

• The Patient Assistance Program gives patients who would otherwise find it financially difficult to receive type 2 diabetes treatment access to a free year of ACTOS therapy.
  • You must meet the required income level, not have medical insurance coverage for prescriptions and/or be ineligible for government or private programs, and must be a legal resident of the United States.
  • If you have Medicare Part D coverage, you may also be eligible to receive assistance.
• For information on how to enroll, call 1-800-830-9159.