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MySavingsRx Card for ONGLYZA:
$0 co-pay for eligible patients prescribed ONGLYZA*

*Subject to eligibility. Restrictions apply. Not available for government-insured patients. Out-of-pocket savings up to $150.

We understand that even with insurance, the monthly out-of-pocket costs for your medicine can really add up, but we want you to know we’re doing something about it.

To help make your prescription costs more affordable, we’re offering every eligible patient a $0 co-pay that lasts as long as your doctor prescribes ONGLYZA. If you have previously activated a MySavingsRx Card for ONGLYZA, you are already enrolled in this offer.

Getting started is easy as 1-2-3:

We’re working to reduce your out-of-pocket prescription costs. So take advantage of the MySavingsRx Card for ONGLYZA today.


ELIGIBILITY REQUIREMENTS 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 prescriptions.
  • Patients who are enrolled in a state or federally funded prescription insurance program are not eligible for this offer. This includes patients enrolled in Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DOD) programs or TriCare, and patients who are Medicare eligible and enrolled in an employer-sponsored group waiver health plan or government-subsidized prescription drug benefit program for retirees.
  • If you are enrolled in a state or federally funded prescription insurance program, you may not use this savings card even if you elect to be processed as an uninsured (cash paying) patient.
  • This offer is not insurance and is restricted to residents of the United States and Puerto Rico. You are 18 years of age or older.

TERMS OF USE: Eligible patients with a valid prescription for:

  • ONGLYZA® (saxagliptin) who present an activated Savings Card at participating pharmacies may be able to pay no more than $0 per 30-day supply for up to 24 months, subject to a maximum savings of $150 per 30-day supply. Other restrictions may apply. Patient is responsible for applicable taxes, if any. Card must be activated before use. Offer valid for up to a total of 24 monthly refills, within 24 months, as prescribed. Every year thereafter, patients will be required to renew eligibility.
  • Activation and first use of the Savings Card must take place by March 31, 2015. This offer will expire on December 31, 2015. For Massachusetts residents only, this offer will expire on July 1, 2015.
  • Non-transferable, limited to one per person, cannot be combined with any other offer. Void where prohibited by law, taxed or restricted.
  • Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer.
  • AstraZeneca reserves the right to rescind, revoke, or amend this offer at any time without notice.
  • This offer is not conditioned on any past, present or future purchase, including refills.
  • Offer must be presented along with a valid prescription for ONGLYZA at the time of purchase.

BY USING THIS CARD, YOU AND YOUR PHARMACIST UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

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MySavingsRx

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