Eligibility criteria: 1. This card is good for use only with a valid Taclonex® Topical Suspension prescription. 2. This card
is good for six prescription fills for Taclonex® Topical Suspension. 3. Maximum of $300 benefit per prescription fill toward
health insurance plan copay or cash price in absence of patient being covered by
a health insurance plan. 4. Different benefits and restrictions apply if
your health insurance plan does not immediately cover the Taclonex® product.* 5.
Program expires on 06/30/13. 6. Offer good only in the USA at participating
retail pharmacies. 7. Original card must be presented to the pharmacist at
the time the prescription is filled. Not valid if reproduced. 8. Only one
card per patient. 9. The selling, purchasing, trading, or counterfeiting
of this card is prohibited by law. 10. Card is not transferable. 11.
You must be 18 years of age or older to be eligible. 12. This card is not
health insurance. 13. Claims submitted to private insurers must fully reflect
all discounts, rebates, or other reductions in price. 14. This card is not
valid for prescriptions reimbursed in whole or in part by Medicaid, Medicare, or
other federal or state programs (including any state prescription drug programs),
or by private indemnity or HMO health insurance plans that reimburse you for the
entire cost of your prescription drugs. Not valid for patients who are Medicare
eligible and enrolled in an employer-sponsored health insurance plan or prescription
drug benefit program for retirees (i.e., you are eligible for Medicare Part D but
receive a prescription drug benefit through a former employer). 15. Offer
void where prohibited by law, taxed, or restricted. 16.
Not valid in combination with any other offers, discounts, or programs. 17.
Card has no cash value. 18. LEO Pharma Inc. redeems this card and reserves
the right to rescind, revoke, or amend this offer without notice. 19. You
understand and agree to the terms and conditions as set forth above.
* A different benefit may be available through this program if:
In such situations, LEO Pharma, the manufacturer of Taclonex® Topical Suspension, may cover the full cost of your prescription for up to
a total of six prescription fills of any combination of the two products. This benefit
may only be available for a limited time. Your participation in the LEO Pharma Copay
Card program does not relieve you of your obligations to comply with your health
insurance plan’s requirements for future Taclonex® product prescription fills. Please
check with your health insurance plan (or other third party payer) regarding restrictions
or limitations on your participation in this program or future coverage of Taclonex®