Answer 3 quick questions to apply for your MULTAQ Savings Card*.
Please indicate that you acknowledge and understand the following statement and confirm that the information you have provided is accurate and complete, as this is necessary for compliance with applicable federal and state laws. This offer is not valid for prescriptions covered by or submitted for reimbursement under Medicaid, Medicare, VA, DOD, TRICARE, or similar federal or state programs including any state pharmaceutical assistance program. Should you begin receiving prescription benefits from any federal, state, or government funded program at any time, you will no longer be eligible to participate in this program. If you have an Affordable Care (Health Care Exchange) plan, you may still be qualified to receive and use this savings card.
Please note: the Federal Employees Health Benefits (FEHB) Program is not a federal or state government health care program for purposes of the savings program. Void where prohibited by law. Savings may vary depending on patients’ out-of-pocket costs. Upon registration, patients receive all program details. Sanofi US reserves the right to rescind, revoke, or amend the program without notice. Do you acknowledge and understand this statement and confirm that the information you have provided is accurate and complete?
Apply for a MULTAQ Savings Card - Step 2
Please note that the MULTAQ Savings Card has no value without a prescription. You can activate your Savings Card, but unless you have an actual prescription, it has no value. Please complete the form below to obtain a MULTAQ Savings Card. By providing your information in the form below, you are also agreeing to receive further communication from MULTAQ.
Please complete the form below