PYLERA® TrialScript® XT Program

Save Up to $45 on Your Prescription for PYLERA®

Patient

To receive up to a $45 rebate on your out-of-pocket cost for PYLERA® take this coupon with your signed prescription to a retail pharmacy.

Coupon not available for prescriptions covered under Medicaid, Medicare, or any other state or federal medical or pharmaceutical assistance program or where otherwise prohibited by federal or state law. Void in Massachusetts except for individuals without insurance coverage for PYLERA®. Aptalis reserves the right to rescind, revoke, or amend this program without notice. Patient is responsible for reporting receipt of program benefits to any insurer that pays for or reimburses any part of the prescriptions filled with this program. Patient agrees not to seek reimbursement for all or any part of the benefit received under this coupon. Offer may not be combined with any other free trial, coupon, discount, or prescription savings card. Offer void where prohibited, taxed, or restricted. It is illegal to sell, purchase, trade, or counterfeit this coupon.

Pharmacist

Submit transaction to McKesson Corporation using BIN # 610524. If primary coverage exists, input card information as secondary coverage (not to exceed the copay amount or $45, whichever is less) and transmit using the COB segment of the NCPDP transaction. Applicable discounts will be displayed in the transaction response. For cash patients, pharmacist agrees to charge not more than the usual and customary retail price less $45. Acceptance of this card and your submission of claims are subject to the Terms and Conditions posted at www.mckesson.com/mprs/.

For questions call McKesson Help Desk at 1-800-657-7613 8 am to 8 pm ET, Monday through Friday.

Information on this website is not intended to replace the advice of your physician(s). Please consider what you learn here a starting point for a conversation with your physician. PYLERA® is a prescription drug; please ask your physician if PYLERA® is right for you.