Program Terms, Conditions,
and Eligibility Criteria

  1. This offer is good for use only with a valid prescription for DELZICOL® (mesalamine) delayed- release capsules at the time the prescription is filled by the pharmacist and dispensed to the patient.

  2. Depending on your insurance coverage, most eligible insured patients may pay as little as $30 for each of up to twelve (12) prescription fills. Check with your pharmacist for your copay discount. Maximum savings limit applies; patient out-of-pocket expense may vary.

  3. This offer is not valid for use by patients enrolled in Medicare, Medicaid, or other federal or state programs (including any state pharmaceutical assistance programs), or private indemnity or HMO insurance plans that reimburse you for the entire cost of your prescription drugs. Patients may not use this card if they are Medicare-eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees. This offer is not valid for cash-paying patients.

  4. This offer is valid for up to twelve (12) prescription fills. Offer applies only to prescriptions filled before the program expires on 07/31/2018.

  5. Allergan reserves the right to rescind, revoke, or amend this offer without notice.

  6. Offer good only in the USA, including Puerto Rico, at participating retail pharmacies.

  7. Void if prohibited by law, taxed, or restricted.

  8. This card is not transferable. The selling, purchasing, trading, or counterfeiting of this card is prohibited by law.

  9. This card has no cash value and may not be used in combination with any other discount, coupon, rebate, free trial, or similar offer for the specified prescription.

  10. This offer is not health insurance.

  11. This card expires July 31, 2018.

  12. By redeeming this card, you acknowledge that you are an eligible patient and that you understand and agree to comply with the terms and conditions of this offer.

  13. For questions about the program, including savings on mail-order prescriptions, please call 1-855-706-8716.

Click here
for full Prescribing Information for DELZICOL.