*CELEBREX $4 Co-pay Card Terms and Conditions
By participating in the CELEBREX® (celecoxib) $4 Co-pay Card program, you acknowledge that you currently meet the eligibility criteria and will comply with the terms and conditions described below:
- The Card is not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare, or other federal or state healthcare programs including any state prescription drug assistance programs and the Government Health Insurance Plan available in Puerto Rico (formerly known as “La Reforma de Salud”)
- The Card is not valid for prescriptions that are eligible to be reimbursed by private insurance plans or other health or pharmacy benefit programs, which reimburse you for the entire cost of your prescription drugs
- Insureds must be 18 or older
- You must deduct the savings received under this program from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf
- Eligible patients will pay a minimum of $4 per prescription fill. By using the Card, eligible patients will receive a savings of up to $75 per fill off their co-pay or out-of-pocket costs. The Card is good for a maximum savings of $1,050 per year ($75 per month x 14 months). The Card limits your prescription cost to $4, subject to a maximum $75 monthly benefit. Thus, if your co-pay or out-of-pocket cost is more than $79, you will save $75 off of your co-pay or total out-of-pocket costs. [Example: If your co-pay or out-of-pocket costs are $100, you will pay $25 ($100-$75=$25)]. If your co-pay or out-of-pocket costs are no more than $79, you pay $4. For a mail-order 3-month prescription, your total maximum savings will be $225 ($75x3)
- The Card is not valid for Massachusetts residents whose prescriptions are covered, in whole or in part, by third-party insurance, or where otherwise prohibited by law
- The Card cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription
- The Card will be accepted only at participating pharmacies
- The Card is not health insurance
- This offer is good only in the U.S. and Puerto Rico
- The Card is limited to one per person during this offering period and is not transferable
- Pfizer reserves the right to rescind, revoke, or amend this offer without notice at any time
- No membership fees
- The Card and Program expire on 12/31/15
For reimbursement when using a nonparticipating pharmacy/mail order: Pay for CELEBREX prescription and mail copy of original pharmacy receipt (cash register receipt NOT valid) with product name, date, and amount circled to: CELEBREX $4 Co-pay Card, 14001 Weston Parkway, Suite 103, Cary, NC 27513. Be sure to include a copy of the front of your $4 Co-pay Card, your name, and mailing address.
Visit www.Celebrex.com for more information about CELEBREX. For help with the CELEBREX $4 Co-pay Card, call 1-855-612-1956, or write: CELEBREX $4 Co-pay Card, 14001 Weston Parkway, Suite 103, Cary, NC 27513. Be sure to include your name and mailing address.
†Generic prescription NSAID patients, including uninsured patients, pay an average of $6.00–$8.00, excluding $0 out-of-pocket claims, as of August 2014.
Scroll for Important Safety Information and Indications.
IMPORTANT SAFETY INFORMATION
All prescription NSAIDs, like CELEBREX, ibuprofen, naproxen, and meloxicam have the same cardiovascular warning. They may all increase the chance of heart attack or stroke that can lead to death. This chance increases if you have heart disease or risk factors for it, such as high blood pressure or when NSAIDs are taken for long periods.
CELEBREX should not be used right before or after certain heart surgeries.
Serious skin reactions, or stomach and intestine problems such as bleeding and ulcers, can occur without warning and may cause death. Patients taking aspirin and the elderly are at increased risk for stomach bleeding and ulcers.
Tell your doctor if you have:
- A history of ulcers or bleeding in the stomach or intestines
- High blood pressure or heart failure
- Kidney or liver problems
CELEBREX should not be taken in late pregnancy.
Do not take CELEBREX if you have bleeding in the stomach or intestine, or you've had an asthma attack, hives, or other allergic reactions to aspirin, any other NSAID medicine or certain drugs called sulfonamides.
Life threatening allergic reactions can occur with CELEBREX. Get help right away if you've had swelling of the face or throat or trouble breathing.
Prescription CELEBREX should be used exactly as prescribed at the lowest dose possible and for the shortest time needed.
CELEBREX is indicated for the relief of the signs and symptoms of osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis, and for the management of acute pain in adults.
Have a question? Call us at 1-888-678-2692.
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