*Max benefit of $200 per monthly prescription fill. See Eligibility and Terms below.
Exclusively for Amneal-labeled Dimethyl Fumarate Delayed-Release Tablets:
To Patient: Commercially insured patients can use this copay card to reduce out-of-pocket expenses on eligible prescriptions filled with Amneal Amneal Dimethyl Fumarate DR Capsules (see strengths listed above). Mention this offer to your pharmacy along with a valid dimethyl fumarate prescription for an FDA-approved use. This offer is valid for a maximum savings of $200 per monthly prescription fill. By using this offer, you acknowledge that you meet the Eligibility Criteria and will comply with the Terms and Conditions set forth below.
To Pharmacist: Offer valid for SECONDARY claims only. Process a Coordination of Benefits (COB/split bill) claim using the patient’s prescription insurance for the PRIMARY claim. Submit the SECONDARY claim to PDM under BIN: 610020. Patient will receive a maximum of $200 off per monthly prescription fill for their out-of-pocket cost.
For pharmacy processing questions, please call 1-855-825-1678.
Eligibility Criteria/Terms & Conditions: Copay card is only available for residents of the US and Puerto Rico who have commercial health insurance with co-pay/co-insurance on each prescription fill per product. Patients may not combine this offer with any rebate, coupon, free trial, or similar offer. Patients must present a valid prescription for an eligible drug at a participating pharmacy. Federal and state laws and other factors may prevent or otherwise restrict eligibility. This offer is not valid in California or Massachusetts. This card is not valid for prescriptions submitted for reimbursement to Medicare, Medicaid, TRICARE, or other federal- or state-funded programs, or private indemnity or HMO insurance plans that reimburse you for the entire cost of your prescription drugs. Patients may not use this card if they are Medicare eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees. The amount of the rebate cannot exceed the patient’s out-of-pocket cost. Void where prohibited by law. This offer is not insurance. Amneal Pharmaceuticals LLC reserves the right to rescind, revoke or amend this offer without notice.
*Max benefit of $200 per monthly prescription fill; $6,000 per calendar year for all Amneal products.
Administered by TrialCard. US Patent No. 7,925,531
©2022 Amneal Pharmaceuticals LLC. All rights reserved. PP-MMT-US-0005