Pay as Little as $15 per Month with the RELEXXII® Savings Card*
Download and Print Your Savings Card
*Co-pay assistance is applicable to prescription coverage for eligible commercially insured patients. Offer void where prohibited. No income restrictions apply. Other restrictions may apply. For full terms and conditions, see below.
RELEXXII® Savings Card Terms & Conditions
By using the RELEXXII® Savings Card ("Card"), you acknowledge that you currently meet the eligibility criteria and will comply with the following terms and conditions:
- The Card is not valid for prescriptions that are eligible to be reimbursed:
- in whole or in part, by Medicaid, Medicare (including Medicare Part D), Tricare, Puerto Rico Government Health Insurance Plan, or any other federal or state-funded healthcare benefit program (collectively, "Government Programs");
- by commercial plans or other health or pharmacy benefit programs that reimburse for the entire cost of prescription drugs
- Eligible commercially insured patients using this Card may pay as little as $15 per month. To qualify for this offer, your out-of-pocket expense must be a minimum of $15 per prescription. Patient, pharmacist, and prescriber agree not to seek reimbursement for all or any part of the benefit received by the patient through the Card. Both patient and pharmacist are each individually responsible for reporting receipt of coupon benefit to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the Card, as required.
- This Card is not health insurance and is not intended as a substitute for health insurance.
- This Card can be used only by eligible residents in the United States and Puerto Rico and only at participating pharmacies. This offer is valid only for patients with a valid prescription for RELEXXII tablets at the time the prescription is filled and dispensed by the pharmacist. Void where prohibited by law, taxed, or restricted.
- The Card is limited to one per person and is not transferable. No substitutions are permitted. It is illegal to sell, purchase, trade, or counterfeit, or offer to sell, purchase, trade, or counterfeit the Card. The Card is available for each valid prescription. No other purchase is necessary. No income restrictions apply. This offer cannot be combined with any other rebate, coupon, free trial, discount, or similar offer.
- Certain information pertaining to your use of the Card will be shared with Alora Pharmaceuticals, LLC, the sponsor of the Card, and its affiliates. The information disclosed may include the date the prescription is filled, the amount of product dispensed by the pharmacists, and the amount of your co-pay that will be paid for by using this Card. For more information, please see Privacy Policy.
- Alora Pharmaceuticals, LLC reserves the right to rescind, revoke, or amend this offer without notice. For expiration date, please refer to the Card.