Eligibility criteria: 1. This card is good for use only with a valid Taclonex® Topical Suspension prescription. 2. This card is valid for up to 6 prescription fills for Taclonex® Topical Suspension. 3. For patients with private health insurance, this card may cover the entire insurance copay or up to $300 of the cash price if you are not insured. 4. Program expires on 6/30/14. 5. Offer good only in the USA at participating retail pharmacies. 6. Original card must be presented to the pharmacist at the time the prescription is filled. Not valid if reproduced. 7. Only one card per patient. 8. The selling, purchasing, trading, or counterfeiting of this card is prohibited by law. 9. Card is not transferable. 10. You must be 18 years of age or older to be eligible. 11. This card is not health insurance. 12. Claims submitted to private insurers must fully reflect all discounts, rebates, or other reductions in price. 13. 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). 14. Offer void where prohibited by law, taxed, or restricted. 15. Not valid in combination with any other offers, discounts, or programs. 16. Card has no cash value. 17. LEO® Pharma Inc. redeems this card and reserves the right to rescind, revoke, or amend this offer without notice. 18. You understand and agree to the terms and conditions as set forth above.
* A different benefit may be available through this program if:
- Your claim for a Taclonex® product is rejected at the pharmacy because your health insurance plan does not cover the Taclonex® product;
- Your health insurance plan requires a prior authorization for the Taclonex® product; or,
- Your health insurance plan requires that you try other medications prior to taking the Taclonex® product.
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. 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® products.