Methylphenidate ER Co-Pay Savings Card Terms & Conditions

By using the Methylphenidate Co-Pay Savings Card ("Card"), you acknowledge that you currently meet the eligibility criteria and will comply with the following terms and conditions:

• The Card is not valid for prescriptions that are eligible to be reimbursed:
  • in whole or in part, by Medicaid, Medicare (including Medicare Part D), Tricare, Puerto Rico Government Health Insurance Plan, or any other federal or state-funded healthcare benefit program (collectively, "Government Programs");
  • by commercial plans or other health or pharmacy benefit programs that reimburse for the entire cost of prescription drugs
• Eligible patients using this Card will pay as little as $5 on their first prescription and as little as $15 for up to 11 fills a year. To qualify for this offer, your out-of-pocket expense must be a minimum of $5 per prescription. Depending on your co-pay and the quantity dispensed, savings may be up to a maximum of $180 for a quantity of 90 tablets on your first prescription, and up to $150 on every prescription for 90 tablets thereafter. Patient, pharmacist, and prescriber agree not to seek reimbursement for all or any part of the benefit received by the patient through the Card. Both patient and pharmacist are each individually responsible for reporting receipt of coupon benefit to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the Card, as required.
• This Card is not health insurance and is not intended as a substitute for health insurance.
• This Card can be used only by eligible residents in the United States and Puerto Rico and only at participating pharmacies. This offer is valid only for patients with a valid prescription for Methylphenidate ER tablets at the time the prescription is filled and dispensed by the pharmacist. Void where prohibited by law, taxed, or restricted.
• The Card is limited to one per person and is not transferable. No substitutions are permitted. It is illegal to sell, purchase, trade, or counterfeit, or offer to sell, purchase, trade, or counterfeit the Card. The Card is available for each valid prescription. No other purchase is necessary. This offer cannot be combined with any other rebate, coupon, free trial, discount, or similar offer.
• Certain information pertaining to your use of the Card will be shared with Alora Pharmacueticals, LLC, the sponsor of the Card, and its affiliates. The information disclosed may include the date the prescription is filled, the amount of product dispensed by the pharmacists, and the amount of your co-pay that will be paid for by using this Card. For more information, please see Privacy Policy.
• Alora Pharmacueticals, LLC reserves the right to terminate, rescind, revoke, or modify the Card at any time without notice. For expiration date, please refer to the Card.