3/9/2015

Nasonex7050HCCCoupon

MULTIUSESAVINGSCOUPON
Eligibleprivatelyinsuredpatientsmaysaveupto$20offtheiroutofpocketcost,
oneachofupto6qualifyingprescriptionsforNASONEX.
Thiscouponisnotinsurance.
NASONEXisaprescriptionmedication.OnlyyourhealthcareprovidercandecidewhetherNASONEXisrightforyou.
RxBIN:610524

RxPCN:Loyalty

RxGRP:50777050

ISSUER:(80840)

ID:329471831

ExpirationDate:12/31/2015

Howthiscouponworks:
Thiscouponcanbeusedupto6timesbeforetheexpirationdateandprovidesa
maximumbenefitofupto$20ortheamountofyouroutofpocketcost,whichever
isless,offoneachofupto6qualifyingprescriptions(regardlessofthequantity
suppliedontheprescription).
Presentthisactivatedcouponandyourinsurancecardwithavalidsigned
prescriptionatanyparticipatingeligibleretailormailorderpharmacy(certain
restrictionsapply).
Ifyouareunabletoredeemthiscouponatyoureligibleretailormailorder
pharmacy,pleasekeepyourreceiptandcallMcKessonCorporationat
8772642454within30daysofpurchasetorequestaDirectMember
Reimbursement(DMR)form.Pleasenote:NotallpatientswillbeeligibleforDirect
MemberReimbursement.MerckmaydiscontinueDirectMemberReimbursement
atanytimewithoutnotice.
Ifyoulosethiscoupon,pleasevisitnasonex.comtoobtainareplacementcoupon.
Regardlessofthenumberofreplacementcouponsreceived,thiscouponofferis
limitedto6prescriptionsforNASONEXperpatientbeforetheexpirationdate.
Notallpatientsareeligibletousethiscoupon.PleaseseeTermsandConditions.
Pleasenote:Thesamecouponoffermaybeavailableindifferentforms.For
example,youmayreceivethecouponfromyourdoctor,oryoumayprintit
yourselffromtheproductWebsite.Regardlessofhowmanycouponsyou
receiveorprint,youmayonlyusethecouponandreceiveupto$20offyour
outofpocketcost,onaneligibleprescriptionupto6timesbeforethe
expirationdateprintedonthecoupon.

AbsentachangeinMassachusettslaw,effectiveJuly1,2015,youagreenotto
processthiscouponforresidentsofMassachusetts.
YouagreenottoprocessthecouponforresidentsofMassachusettsifan
ABratedgenericequivalentforNASONEXisapprovedbytheUnitedStates
FoodandDrugAdministration.
Youagreetonotifythepatient'sinsurancecarrierofthiscouponredemption,as
mayberequiredbythetermsandconditionsofyourrelationshipwiththeinsurance
carrier.
Thiscouponmaynotbeappliedtowardanyotherpharmacypurchase.
McKessonCorporationreservestherighttoauditandreviewallrecordsand
documentationrelatingtotheredemptionofthiscouponandthedispensingof
product.

TermsandConditions:

Prescriber:
Toinitiateacouponforanappropriatepatienttouseupto6times,youshould:
ReadthePrescribingInformationbeforeprescribingNASONEX.Forcopiesof
thePrescribingInformation,call8006726372,visitnasonex.com,orcontactyour
Merckrepresentative.
WriteaprescriptionforNASONEX.Nosubstitutionsarepermitted.
Givethevalidsignedprescriptionandthiscoupontothepatientalongwiththe
PatientInformationforNASONEX.
Eligiblepatientscantakeorsendthiscouponandthesignedprescriptiontoany
participatingeligibleretailormailorderpharmacytoreceivesavingsontheiroutof
pocketcost(savingswillvarydependingontheiroutofpocketcost).
Notallpatientsareeligibletousethiscoupon.PleaseseeTermsandConditions.

Pharmacist:
CouponisvalidonlywhenaccompaniedbyaprescriptionforNASONEX.Coupon
valuemaynotexceedactualoutofpocketcostor$20,whicheverisless.Please
reviewTermsandConditionsonthecouponforimportanteligibility
restrictions.
SubmittransactiontoMcKessonCorporationusingBINNo.610524.For
pharmacyprocessingquestions,pleasecalltheMcKessonHelpDeskat
8772642454(8AM8PMET,MondayFriday).
Inputcouponinformationassecondarycoverageandtransmitusingthe
CoordinationofBenefits(COB)segmentoftheNationalCouncilforPrescription
DrugPrograms(NCPDP)transaction.Applicablediscountswillbedisplayedinthe
transactionresponse.
Uninsured,cashpayingpatientsarenoteligibletousethecoupon.Forprivately
insuredpatientswithoutcoverageforNASONEX,youagreetochargenomore
thantheusualandcustomaryretailprice(subjecttorestrictionssetbyMcKesson).
Foranyotherprescriptions,pleaseusethepatientsprimarymethodofpayment
andanewRxnumber.PleasecleartheCOBsecondaryscreenafterprocessing
thetransaction.
AcceptanceofthiscouponandyoursubmissionofclaimsaresubjecttotheTerms
andConditions,postedatwww.mckesson.com/mprstnc,andtheTermsand
Conditionsofthiscoupon.
Byprocessingthiscoupon,youagreethatNASONEXwasdispensedpursuantto
thiscouponandthatyouwillnotsubmitaclaimforreimbursementtoany
GovernmentProgramortoanyExchangePlan(asthosetermsaredefinedinthe
TermsandConditions).

Thiscouponisvalidforupto$20offyouroutofpocketcost,oneachofupto6
qualifyingprescriptionsforNASONEX(regardlessofthequantitysuppliedonthe
prescription).
Couponisvalidforuse6timesonly.Patientmusthaveacopayment(or,if
privatelyinsuredwithoutcoverageforNASONEXmakefullcashpayment)forthe
prescription.Savingsarelimitedtoamountofyouroutofpocketcost,uptoa
maximumof$20perprescriptionforupto6qualifyingprescriptions.
Nootherpurchaseisnecessary.
Thiscouponisnottransferable.Nosubstitutionsarepermitted.Thisoffercannotbe
combinedwithanyothercoupon,freetrial,discount,prescriptionsavingscard,or
otheroffer.
Thiscouponisnotinsurance.
Patientmusthaveprivateinsurance.Notvalidforuninsuredpatientsor
patientscoveredunderMedicaid,Medicare,aMedicarePartDorMedicare
Advantageplan(regardlessofwhetheraspecificprescriptioniscovered),
TRICARE,CHAMPUS,PuertoRicoGovernmentHealthInsurancePlan
("HealthcareReform"),oranyotherstateorfederalmedicalor
pharmaceuticalbenefitprogramorpharmaceuticalassistanceprogram
(collectively,"GovernmentPrograms").
Thiscouponisnotvalidforpatientscoveredunderanyqualifiedhealthplan
purchasedthroughahealthinsuranceexchange(marketplace)established
byastategovernmentorthefederalgovernment(ExchangePlan).
AbsentachangeinMassachusettslaw,effectiveJuly1,2015,thiscoupon
willnolongerbevalidforresidentsofMassachusetts.
NotvalidforresidentsofMassachusettsifanABratedgenericequivalentfor
NASONEXisapprovedbytheUnitedStatesFoodandDrugAdministration.
Youmustbe18yearsofageoroldertoredeemthiscouponforyourselforminor
(otheragerestrictionsmayapply).Patient,guardian,pharmacist,andprescriber
agreenottoseekreimbursementforalloranypartofthebenefitreceivedbythe
recipientthroughthisoffer.Patientorguardianisresponsibleforreportingreceipt
ofcouponbenefittoanyinsurer,healthplan,orotherthirdpartywhopaysforor
reimbursesanypartoftheprescriptionfilledusingthiscoupon,asmayberequired.
ThiscouponcanbeusedonlybyeligibleresidentsoftheUnitedStatesorthe
CommonwealthofPuertoRicoatparticipatingeligibleretailormailorder
pharmaciesintheUnitedStatesortheCommonwealthofPuertoRico.Product
mustoriginateintheUnitedStatesortheCommonwealthofPuertoRico.
ThiscouponisthepropertyofMerckandmustbeturnedinonrequest.
Itisillegaltosell,purchase,trade,orcounterfeit,oroffertosell,purchase,
trade,orcounterfeitthiscoupon.Voidifreproduced.Voidwhereprohibited
bylaw,taxed,orrestricted.
Merckreservestherighttorescind,revoke,oramendthisofferatanytimewithout
notice.
Datarelatedtoyourredemptionofthiscouponmaybecollected,analyzed,and
sharedwithMerck,formarketresearchandotherpurposesrelatedtoassessing
couponprograms.DatasharedwithMerckwillbeaggregatedanddeidentified,
meaningitwillbecombinedwithdatarelatedtoothercouponredemptionsandwill
notidentifyyou.
ExpirationDate:12/31/2015.

Copyright2014MerckSharp&DohmeCorp.,asubsidiaryofMerck&Co.,Inc.Allrightsreserved.RESP1135568000011/14

https://www.activatethecard.com/7050/validateReplacement.html#

1/1