SEEBRI NEOHALER Savings Programs

SEEBRI NEOHALER Savings Programs

Learn How Your Patients Can Pay as Little as $10 for SEEBRI NEOHALER

Learn How Your Patients Can Pay as Little as $10 for SEEBRI NEOHALER*

Once you have prescribed SEEBRI NEOHALER, your patient can confirm his or her eligibility for co-pay savings at the filling pharmacy.

SEEBRI® savings brochure

SEEBRI® savings brochure

STEP 1:
Your patient should bring the SEEBRI NEOHALER Savings Brochure to his or her pharmacy

STEP 1:
Your patient should bring the SEEBRI NEOHALER Savings Brochure to his or her pharmacy

SEEBRI® cost savings

SEEBRI® cost savings

STEP 2:
Automatic savings will be applied at participating pharmacies*

STEP 2:
Automatic savings will be applied at participating pharmacies*

SEEBRI® NEOHALER® prescription savings card

SEEBRI® NEOHALER® prescription savings card

STEP 3:
If savings are not automatically applied, your patient can provide the pharmacy with the SEEBRI NEOHALER Prescription Savings Program Card* enclosed in the Savings Brochure

STEP 3:
If savings are not automatically applied, your patient can provide the pharmacy with the SEEBRI NEOHALER Prescription Savings Program Card* enclosed in the Savings Brochure

eVoucher Rx™ PROGRAM
As a participant in the eVoucherRx Program powered by RelayHealth, Sunovion has made it possible to extend prescription savings on to your patients. eVoucherRx is a paperless electronic coupon program that makes co-pay savings on SEEBRI NEOHALER easy for you and your patients.

PARTICIPATING PHARMACIES
When your patient presents his or her SEEBRI NEOHALER prescription at a participating pharmacy, eVoucherRx will automatically apply co-pay savings so your patient may pay as little as $10. For participating pharmacy locations, visit www.evoucherrx.relayhealth.com/storelookup.

OTHER PHARMACIES
Patients who do not have access to a participating pharmacy can present the SEEBRI NEOHALER Prescription Savings Program Brochure with card to their pharmacist to receive their savings. Prior to visiting the pharmacy, your patient should activate the card by calling 1-844-276-8262 or by visiting www.SEEBRI.us. Request savings card for your patients below.

*Limitations apply. See program Terms and Conditions. This card is valid for up to $250 off each of up to 12 qualifying prescriptions of SEEBRI NEOHALER for up to a 30-day supply. Valid only for those with commercial insurance. This offer is not valid under Medicare, Medicaid, or any other federal or state program. Cash-paying patients will save up to $250 off the cost of their prescription. Sunovion Pharmaceuticals Inc. reserves the right to rescind, revoke, or amend this program without notice.

For patients who are not able to find an eVoucherRx participating pharmacy, you can request SEEBRI NEOHALER Savings Cards

SEEBRI® NEOHALER® savings card

SEEBRI® NEOHALER® savings card

Eligible patients pay as little as $10 co-pay.

Restrictions apply. SEEBRI NEOHALER Savings Program Terms & Conditions.

Get patients started with a free trial offer

SEEBRI® NEOHALER® 30-day free trial voucher

SEEBRI® NEOHALER® 30-day free trial voucher

Restrictions apply. SEEBRI NEOHALER Free Trial Program Terms & Conditions.

Help patients meet high deductibles

High-deductible discount card

High-deductible discount card

Save up to $400 per prescription on SEEBRI NEOHALER.§

§Restrictions apply. SEEBRI NEOHALER High-Deductible Discount Card Program Terms & Conditions.

Log in to request Savings Cards, Free Trial Offer, or High-Deductible Discount Cards.

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Savings Card Terms and Conditions

By using this program, you acknowledge that you currently meet the following eligibility requirements:
You must be 18 years of age or older to accept this offer. This offer is valid only for eligible patients and legal guardians of eligible patients. Patients must have a valid prescription for SEEBRI NEOHALER within SEEBRI NEOHALER approved indication. Offer not valid if prescription is paid in part or full by any state or federally funded health care program, including but not limited to Medicare, Medicaid, VA, DoD or TRICARE, or where prohibited by law.

This program is valid for up to $250 off each prescription fill for up to a 30-day supply. The program is further limited to twelve (12) qualifying prescription fills. Offer is limited to one per person and may not be used with any other offer. This program is not health insurance. The amount of the benefit cannot exceed the patient’s out-of-pocket expenses.

Acceptance of this offer must be consistent with the terms of any drug benefit provided by a health insurer, health plan, or other third-party payer. If requested or required by any such payer, the patient must report the use of this program. The patient must deduct the value of the savings received under this program from any reimbursement request submitted to the patient’s insurance plan, either directly or on the patient’s behalf.

For California and Massachusetts residents, benefits pursuant to this program will terminate automatically upon the introduction of a therapeutically equivalent product. Offer valid only in the United States and Puerto Rico. Void where prohibited by law, taxed or restricted. Sunovion reserves the right to rescind, revoke or amend this offer at any time without notice. This offer is not transferable and may not be sold, purchased, or traded, or offered for sale, purchase, or trade.

To the Patient: You must present this card, if applicable, to the pharmacist along with your prescription to participate in this program. If you have any questions regarding your eligibility or benefits, or if you wish to discontinue your participation, call the SEEBRI NEOHALER Savings Program at 1-844-276-8262 8:00AM—8:00PM (EST), Monday through Friday. By using this program, you are certifying that you understand the enclosed program rules, regulations, and terms and conditions; you have not submitted and will not submit a claim for reimbursement under any federal, state, or other governmental program for this prescription or where otherwise prohibited by law in your state; and you will otherwise comply with the terms mentioned herein.

To the Pharmacist: When you use this program, you are certifying that you have not submitted and will not submit a claim for reimbursement under any federal, state, or other governmental program for this prescription. If benefit does not apply automatically, submit transaction to McKesson Corporation using BIN #610524. If primary commercial prescription insurance exists, input program information as secondary coverage and transmit using the COB segment of the NCPDP transaction. Applicable discounts will be displayed in the transaction response. Acceptance of this program and your submission of claims for the program are subject to the LoyaltyScript® program Terms and Conditions posted at www.mckesson.com/mprstnc. Patient is not eligible if prescriptions are paid in part or full by any state or federally funded health care program, including but not limited to Medicare or Medicaid, VA, DoD or TRICARE, or where prohibited by law. For questions regarding setup, claim transmission, patient eligibility, or other issues, call the LoyaltyScript® Savings Program at 1-844-276-8262, 8:00AM—8:00PM (EST), Monday through Friday.

 

Free Trial Offer Terms and Conditions

Limit One TrialScript® voucher per patient. Redeem for product only when affixed to the back of a valid, signed prescription form for SEEBRI NEOHALER. Submit claim to McKesson Corporation using BIN #610524. For pharmacy processing questions, please call the Help Desk at 1-800-657-7613.

To the Patient: This voucher is good for one 30-day free trial of SEEBRI NEOHALER. Present this voucher at a participating pharmacy along with a valid prescription from your health care professional.
Need help? Call: 1-800-657-7613.

To the Pharmacist: Must be accompanied by a valid prescription for one 30-day supply of SEEBRI NEOHALER. Dispense as written at no cost to patient. For reimbursement, please submit to McKesson  Corporation. The information provided above should be used when submitting for reimbursement. Do not submit to any other payer, public or private, for reimbursement. This voucher can be used up to 2 times (once per 12-month period).

For questions, please call the Help Desk at 1-800-657-7613.

No substitutions permitted. No purchase required. This is not a discount or rebate. Limitations apply.

Expiration Date: 03/31/2019.

TrialScript® is a registered trademark of McKesson Corporation.


High-Deductible Discount Card Program Terms and Conditions

Restrictions apply. This card is valid for up to $400 off each of up to 3 qualifying prescriptions of SEEBRI NEOHALER, per calendar year, for a 30-day supply. For a 90-day prescription fill, this card may only be used once. Patient is responsible for any additional out-of-pocket costs above $400. Valid only for those with high-deductible commercial insurance. This offer is not valid under Medicare, Medicaid, or any other federal or state program. Cash-paying patients are not eligible. Offer is not valid where prohibited by law. Valid only in the US and Puerto Rico. This program is not health insurance. This card is the property of Sunovion Pharmaceuticals Inc. and must be returned upon request. Offer may not be combined with any other rebate, coupon, or offer. Sunovion Pharmaceuticals Inc. reserves the right to rescind, revoke, or amend this offer at any time. This offer will expire on 12/31/2018.

To the Patient: You must present this card to the pharmacist along with your prescription to participate in this program. If you have any questions regarding your eligibility or benefits, or if you wish to discontinue your participation, call the High-Deductible Discount Card Program at 833-477-0231 (8am-8pm ET Monday through Friday). When you use this card, you are certifying that you understand the program rules, regulations, and Terms and Conditions. You are not eligible if prescriptions are paid for by any state or other federally funded programs, including, but not limited to Medicare or Medicaid, VA, DOD, TRICARE, or where prohibited by law; and you will otherwise comply with the terms above. 

To the Pharmacist: When you use this card, you are certifying that you have not submitted and will not submit a claim for reimbursement under any federal, state, or other governmental programs for this prescription.

  • Submit transaction to McKesson Corporation using BIN #610524
  • If patient has primary prescription insurance, input card information as secondary coverage and transmit using the COB segment of the NCPDP transaction. Applicable discounts will be displayed in the transaction response
  • Acceptance of this card and your submission of claims for the High-Deductible program are subject to the LoyaltyScript® program Terms and Conditions posted at www.mckesson.com/mprstnc
  • Patient is not eligible if prescriptions are paid for in part or full by any state or federally funded programs, including but not limited to Medicare or Medicaid, VA, DOD, TRICARE, or where prohibited by law
  • For questions regarding setup, claim transmission, patient eligibility or other issues, call the High-Deductible Discount Card Program at 833-477-0231 (8AM-8PM ET Monday through Friday) 

Important Safety Information & Indication

Important Safety Information

SEEBRI NEOHALER is contraindicated in patients with a hypersensitivity to glycopyrrolate or to any of the ingredients.

SEEBRI NEOHALER should not be initiated in patients with acutely deteriorating or potentially life-threatening episodes of COPD or used as rescue therapy for acute episodes of bronchospasm. Acute symptoms should be treated with an inhaled short-acting beta2-agonist.

As with other inhaled medicines, SEEBRI NEOHALER can produce paradoxical bronchospasm that may be life threatening. If paradoxical bronchospasm occurs following dosing with SEEBRI NEOHALER, it should be treated immediately with an inhaled, short-acting bronchodilator; SEEBRI NEOHALER should be discontinued immediately and alternative therapy instituted.

Immediate hypersensitivity reactions have been reported with SEEBRI NEOHALER. If signs occur, discontinue immediately and institute alternative therapy. SEEBRI NEOHALER should be used with caution in patients with severe hypersensitivity to milk proteins.

SEEBRI NEOHALER should be used with caution in patients with narrow-angle glaucoma and in patients with urinary retention. Prescribers and patients should be alert for signs and symptoms of acute narrow-angle glaucoma (e.g., eye pain or discomfort, blurred vision, visual halos or colored images in association with red eyes from conjunctival congestion and corneal edema) and of urinary retention (e.g., difficulty passing urine, painful urination), especially in patients with prostatic hyperplasia or bladder-neck obstruction. Patients should be instructed to consult a physician immediately should any of these signs or symptoms develop.

The most common adverse events reported in ≥1% of patients taking SEEBRI NEOHALER, and occurring more frequently than in patients taking placebo, were upper respiratory tract infection (3.4% vs 2.3%), nasopharyngitis (2.1% vs 1.9%), oropharyngeal pain (1.8% vs 1.2%), urinary tract infection (1.4% vs 1.3%), and sinusitis (1.4% vs 0.7%).

SEEBRI capsules must not be swallowed as the intended effects on the lungs will not be obtained. SEEBRI capsules are only for oral inhalation and should only be used with the NEOHALER device.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

For additional information, please see full Prescribing Information and Patient Information for SEEBRI NEOHALER.

Indication

SEEBRI® NEOHALER® (glycopyrrolate) is an anticholinergic indicated for the long-term, maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema.