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 UTIBRON NEOHALER easy for you and your patients.
When your patient presents his or her UTIBRON 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 http://evoucherrx.relayhealth.com/storelookup.
*Restrictions apply. UTIBRON NEOHALER eVoucherRx Co-Pay Program Terms & Conditions.
eVoucherRx is a registered trademark of RelayHealth and/or its affiliates. All rights reserved.
Eligible patients pay as little as $0 co-pay.†
†Restrictions apply. UTIBRON NEOHALER Savings Program Terms & 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 within the approved indication for UTIBRON NEOHALER. Offer not valid if prescription is paid under a cash benefit or 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 for each prescription fill for up to a 30-day supply. The program is further limited to twelve (12) qualifying prescription fills per calendar year. 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: If you have any questions regarding your eligibility or benefits, call 1-844-276-8262, 8AM–8PM ET, Monday through Friday.
Limitations apply. This card is valid for up to $250 off each of up to 12 qualifying prescriptions of UTIBRON for up to a 30-day supply. Valid only for those with commercial insurance. Offer 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. 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.
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 UTIBRON NEOHALER Co-pay Card program at 844-276-8262 (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, Medigap, VA, DOD or 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.
Sunovion Pharmaceuticals Inc. reserves the right to rescind, revoke, or amend this offer at any time.
Limit One TrialScript® voucher per patient. Redeem for product only when affixed to the back of a valid, signed prescription form for UTIBRON 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 UTIBRON 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 UTIBRON 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.
Restrictions apply. This card is valid for up to $400 off each of up to 3 qualifying prescriptions of UTIBRON™ 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.
All LABAs, including indacaterol, are contraindicated in patients with asthma without the use of a long-term asthma-control medication; UTIBRON NEOHALER is also contraindicated in patients with a history of hypersensitivity to indacaterol, glycopyrrolate, or to any of the ingredients.
UTIBRON 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.
UTIBRON NEOHALER should not be used more often, at higher doses than recommended, or in conjunction with other medicines containing LABAs as an overdose may result. Patients who have been taking inhaled short-acting beta2-agonists on a regular basis should be instructed to discontinue their regular use and to use them only for symptomatic relief of acute respiratory symptoms. Clinically significant cardiovascular effects and fatalities have been reported in association with excessive use of inhaled sympathomimetic drugs. Patients using UTIBRON NEOHALER should not use another medicine containing a LABA for any reason.
Immediate hypersensitivity reactions have been reported with UTIBRON NEOHALER. If signs occur, discontinue immediately and institute alternative therapy. UTIBRON NEOHALER should be used with caution in patients with severe hypersensitivity to milk proteins.
As with other inhaled medicines, UTIBRON NEOHALER can produce paradoxical bronchospasm that may be life threatening. If paradoxical bronchospasm occurs following dosing with UTIBRON NEOHALER, it should be treated immediately with an inhaled, short-acting bronchodilator; UTIBRON NEOHALER should be discontinued immediately and alternative therapy instituted.
Indacaterol, like other beta2-adrenergic agonists, can produce a clinically significant cardiovascular effect in some patients as measured by increases in pulse rate, systolic or diastolic blood pressure, or symptoms. UTIBRON NEOHALER should be used with caution in patients with cardiovascular disorders, especially coronary insufficiency, cardiac arrhythmias, and hypertension. Beta2-adrenergic agonists may produce significant hypokalemia in some patients.
As with other beta2-adrenergic agonists, indacaterol should be administered with extreme caution in patients being treated with monoamine oxidase inhibitors, tricyclic antidepressants, or other drugs known to prolong the QTc interval because these agents may potentiate the action of adrenergic agonists on the cardiovascular system.
As with other beta2-adrenergic agonists, UTIBRON NEOHALER should be used with caution in patients treated with additional adrenergic drugs, non-potassium-sparing diuretics, and beta-blockers.
UTIBRON NEOHALER, like all medicines containing sympathomimetic amines, should be used with caution in patients with convulsive disorders, thyrotoxicosis, diabetes mellitus, ketoacidosis, and in patients who are unusually responsive to sympathomimetic amines.
UTIBRON 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 UTIBRON NEOHALER, and occurring more frequently than in patients taking placebo, were nasopharyngitis (4.1% vs 1.8%), hypertension (2.0% vs 1.4%), back pain (1.8% vs 0.6%), and oropharyngeal pain (1.6% vs 1.2%).
UTIBRON capsules must not be swallowed as the intended effects on the lungs will not be obtained. UTIBRON 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.
UTIBRON™ NEOHALER® (indacaterol and glycopyrrolate) is a combination of indacaterol and glycopyrrolate indicated for the long-term, maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema.
Important limitations: UTIBRON NEOHALER is not indicated to treat acute deteriorations of COPD and is not indicated to treat asthma.