RELEXXII^® Savings Offers

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 $0 per month. To qualify for this offer, your out-of-pocket expense must be a minimum of $0 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.
• The offer may be subject to caps on per-fill, annual or lifetime benefits.
• This offer applies only to the patient’s eligible out-of-pocket prescription costs (including co-pay, co-insurance, and deductible amounts) and does not cover any other healthcare costs.
• This Card is not health insurance and is not intended as a substitute for health insurance.
• Some commercial health plans use benefit designs commonly referred to as “accumulator” or “maximizer” programs, which may not apply amounts paid under this offer toward a patient’s deductible or out of pocket maximum. This savings offer is intended solely for the benefit of the patient. Alora Pharmaceuticals, LLC, or its affiliates, reserves the right, in its sole discretion, to modify or discontinue benefits under this offer, or to exclude patients from the offer, if a patient’s plan or its agent implements an accumulator, maximizer, or similar program that changes the way amounts provided under this offer are applied to the patient’s cost sharing obligations.
• 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 an FDA-approved indication and dispensed by a pharmacist pursuant to a valid prescription. 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 terminate, rescind, revoke, or modify the Card at any time without notice.