Terms and Conditions

 

Eligibility

Patients may be eligible for this savings offer if they have commercial insurance and insurance does not cover the full cost of the prescription, or if they are not insured and are responsible for the cost of their prescriptions. Patients are not eligible for this program if they are covered by any federal or state prescription insurance program. This includes patients enrolled in Medicare Part B, Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DoD) programs or TRICARE. This may also include state pharmaceutical assistance programs and other federal or state plans not listed. Patients are also ineligible for this program if they are Medicare eligible and enrolled in an employer-sponsored group waiver health plan or government subsidized prescription drug benefit program for retirees. Patients enrolled in a state or federally funded prescription insurance program may not use this program even if they elect to be processed as an uninsured (cash-paying) patient. Those on Medicare Part D, even if in the coverage gap, are not eligible. Patients enrolled in private indemnity or HMO insurance plans that reimburse them for the entire cost of their prescription drugs are also not eligible. This savings offer is not health insurance and is restricted to residents of the United States, Puerto Rico, and US territories. Void where prohibited by law, taxed, or restricted.

 

Terms of Use

You must have a valid prescription at the time of purchase for one of the following GSK inhalers: Advair Diskus (fluticasone propionate and salmeterol inhalation powder), Advair HFA (fluticasone propionate and salmeterol inhalation aerosol), Anoro Ellipta (umeclidinium and vilanterol inhalation powder), Arnuity Ellipta (fluticasone furoate inhalation powder), Breo Ellipta (fluticasone furoate and vilanterol inhalation powder), Incruse Ellipta (umeclidinium inhalation powder), Serevent Diskus (salmeterol xinafoate inhalation powder), Trelegy Ellipta (fluticasone furoate, umeclidinium, and vilanterol inhalation powder), and Ventolin HFA (albuterol sulfate inhalation aerosol).

 

Eligible commercially insured/covered patients with no restrictions (step edit, prior authorization, or NDC block) or patients who are uninsured who present this savings offer at participating pharmacies will pay no more than $35 for each inhaler when the price charged for the product does not exceed the wholesale acquisition cost (WAC). Patient’s out-of-pocket cost (the amount paid after insurance deductions) if any, may vary. This savings offer is valid for up to twelve (12) uses per product, and each inhaler counts as one (1) use. Other restrictions may apply. Patient is responsible for applicable taxes, if any. This savings offer is limited to (one) 1 person, is nontransferable, and cannot be combined with any other coupon, free trial, or similar offer. Substitutions are not permitted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the amount received by the patient through this savings offer. Savings offer is not valid for: Massachusetts residents if an AB-rated generic equivalent is available; California residents if an FDA approved therapeutic equivalent is available.

 

Other state restrictions may apply. Your acceptance of this savings offer must be consistent with the terms of any drug benefit plan provided to you by your health insurer. You agree to report your use of this coupon to your health insurer if required. This savings offer may not be sold, purchased, traded, or counterfeited. Duplicates of this uniquely coded offer are invalid and not redeemable at the pharmacy. This savings offer   is not conditioned on any past, present, or future purchase, including refills. This savings offer expires on 12/31/2025.

 

ADDITIONAL PROGRAM TERMS AND CONDITIONS: At its sole discretion and with or without notice, GSK or McKesson may reduce, eliminate, or otherwise modify the savings offer for any reason and anytime, including but not limited to if your commercial drug insurance plan imposes additional requirements which limits or prevents you from receiving coverage for your inhaler, only allows partial coverage for your inhaler, removes coverage for your inhaler and requires you to utilize the card, does not provide a material level of financial assistance for the cost of your inhaler, or does not apply program payments to satisfy your co-payment, deductible, or coinsurance for your inhaler. You must meet the eligibility criteria, terms and conditions every time you use this savings offer.

 

Some insurance plans have established programs referred to as ‘accumulator adjustment’ or ‘co-pay maximizer’ programs which require you to enroll in a manufacturer copay assistance program. An accumulator adjustment program is one in which payments made by you that are subsidized by manufacturer assistance do not count toward your deductibles and other out-of-pocket cost sharing limitations. Co-pay maximizers are programs in which the amount of your out-of-pocket costs is increased to reflect the availability of support offered by a manufacturer assistance program. Except where prohibited by applicable state law, if your insurance company, health plan or other company implements either an accumulator adjustment or co-pay maximizer program, you will not be eligible for, and agree not to use, this savings offer because these programs are inconsistent with our agreed intent that this savings offer is solely for your benefit. Since you may be unaware whether you are subject to a co-pay maximizer program when you enroll in the copay assistance Program, if GSK suspects or is made aware that you are subject to one of these programs, we reserve the right to discontinue copay assistance at any time.