Program Terms, Conditions, and Eligibility Criteria

  1. This offer is valid only for patients 18 years of age or older and is good for use only with a valid prescription for VIBERZI® (eluxadoline) 75 mg or 100 mg tablets at the time the prescription is filled by the pharmacist and dispensed to the patient.

  2. Depending on your insurance coverage, for your first prescription fill under this offer, most eligible patients may pay as little as $30 on a 90-day supply or $0 for a 30-day supply and as little as $30 per 30, 60, or 90-day supply for each of up to twelve (12) additional prescription fills. One 60-day supply counts as two (2) fills and one 90-day supply counts as three (3) fills of the total twelve (12) fills. Patients using this savings card for a 90-day supply are not eligible to receive a 30-day supply refill for $0. Check with your pharmacist for your copay discount. Maximum savings limit applies; patient out-of-pocket expense may vary.

  3. This card 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 thirteen (13) prescription fills of a 30-day supply. Offer applies only to prescriptions filled before the program expires on 11/30/18.

  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. Due to state regulation, patients are only able to receive a 30-day supply in New York state.

  7. Void if prohibited by law, taxed, or restricted. Patients residing in states where there are prohibitions or limitations on prescribing and/or dispensing VIBERZI above certain quantities may not be eligible to participate in this offer.

  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 November 30, 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.

For questions about the program, including savings on mail-order prescriptions, please call 1-844-453-3487.

Allergan® and its design are trademarks of Allergan, Inc.

VIBERZI® and its design are registered trademarks of Allergan Holdings Unlimited Company.

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