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Daytrana
Daytrana
Save up to $60
To reduce the cost of your Daytrana patches, print this offer or save the file
to your mobile phone and bring to the pharmacy each time you fill your childs
prescription. Offer is valid for up to 12 prescriptions.
BIN# 004682
PCN# CN
GRP#
EC62001017
ID#
48581357287
This special cost savings offer is for commercially insured and cash-paying patients. This card is not insurance. It is not valid for prescriptions covered
by or submitted for reimbursement under Medicaid, Medicare, or similar federal or state programs, including any state medical pharmaceutical
assistance program. If you are covered by one of these programs, please visit daytrana.com for a free trial offer. Offer limited to one use per month.
The amount of the rebate cannot exceed the patients out-of-pocket expenses.
Patient Instructions: This offer is valid for out-of-pocket expenses for Daytrana patches. Receive up to $60 off each prescription for up to
12 prescriptions or until this coupon expires on 12/31/13. Offer is not transferable. You must bring this offer with you to your pharmacy with a valid
prescription each time you fill Daytrana. By using this offer, you acknowledge that you meet the eligibility criteria and will comply with these terms
and conditions. If you have any questions regarding this offer, please call 1-866-849-4512.
Pharmacist instructions for a patient with Eligible Third Party: Submit the claim to the primary Third Party Payer first, then submit the balance due
to Therapy First Plus for COB (coordination of benefits) with patient responsibility amount and a valid Other Coverage Code (e.g. 8). The patient
pay amount will be reduced by up to $60 and reimbursement will be received from Therapy First Plus.
Pharmacist instructions for cash paying patient: Submit the claim to Therapy First Plus. A valid Other Coverage Code (e.g. 1) is required.
The patient pay amount will be reduced by up to $60 and reimbursement will be received from Therapy First Plus.
Other Coverage Code required: For any questions regarding Therapy First Plus online processing, please call the Help Desk at 1-800-422-5604
Program managed by PSKW, LLC on behalf of Noven Therapeutics, LLC. The parties reserve the right to change or end this program at any time.
Not valid if reproduced. Void where prohibited by law. Product dispensed pursuant to program rules, and federal and state laws. One offer
per person.
Call 1-800-420-2719: Our specialists are available Monday through Friday, 8 AM 9 PM EST
Well help you fill your prescription: A Pharmacy Locator specialist will contact your preferred
local pharmacy to determine the availability of Daytrana. If your preferred pharmacy does not
have Daytrana in stock, we will call the surrounding pharmacies in your area to locate a pharmacy
that either has Daytrana in stock, or can quickly receive a supply in 5 days or less.
Please see Use of the Daytrana Patch and Important Safety Information including
Boxed Warning regarding abuse and dependence on previous page.
Daytrana and the Graphic Design are registered trademarks of Noven Therapeutics, LLC.
2013 Noven Therapeutics, LLC. All rights reserved. For U.S. Audience Only. DAY-3534-13 6/13