![]() If your commercial insurance plan does not cover BEVESPI AEROSPHERE, use of this offer permits your health care provider or pharmacy to share limited information with certain AstraZeneca vendors to determine if additional resources may be available to you and to act on your behalf to initiate any processes that may be necessary to access these resources. Offer must be presented along with a valid prescription for BEVESPI AEROSPHERE at the time of purchase. This offer is not conditioned on any past, present, or future purchase, including refills. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer.ĪstraZeneca reserves the right to rescind, revoke, or amend this offer, eligibility, and terms of use at any time without notice. Void where prohibited by law, taxed, or restricted. Non-transferable, limited to one per person, cannot be combined with any other offer. If you have any questions regarding this offer, please call 1-84 1-84. Patient is responsible for applicable taxes, if any. If you pay cash for your prescription or are insured and your insurance does not cover or has a managed care restriction on your prescription (step-edit, prior authorization, or NDC block), you will receive up to $ 100 in savings on your out-of-pocket costs for each 30-day supply (1 inhaler). If you use a mail-order pharmacy, please contact your pharmacy provider to confirm if this offer will be accepted.Įligible commercially insured/covered patients with no restrictions (step-edit, prior authorization, or NDC block) and with a valid prescription for BEVESPI AEROSPHERE® (glycopyrrolate 9 mcg/formoterol fumarate 4.8 mcg) who present this savings card at participating pharmacies may pay as low as $ 0, subject to a maximum savings limit of $ 100 per 30-day supply (1 inhaler) patient out-of-pocket expenses may vary. This offer is not insurance, is restricted to residents of the United States and Puerto Rico, and to patients over 18 years of age, subject to label indication. If you are enrolled in a state or federally funded prescription insurance program, you may not use this savings card even if you elect to be processed as an uninsured (cash-paying) patient. This includes patients enrolled in Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DOD) programs or TriCare, and patients who are Medicare eligible and enrolled in an employer-sponsored group waiver health plan or government-subsidized prescription drug benefit program for retirees. Patients who are enrolled in a state or federally funded prescription insurance program are not eligible for this offer. You may be eligible for this offer if you are insured by commercial insurance and your insurance does not cover the full cost of your prescription, or you are not insured and are responsible for the cost of your prescriptions.
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