For U.S. Residents Only

Multaq Savings Card
Program

YOU MAY QUALIFY FOR A $0 CO-PAY*

The outline of a co-pay card, with static text that reads"$0 CO-PAY"
With the MULTAQ Savings Card, you may be eligible for a $0 co-pay on each of your next 13 MULTAQ fills, with no income restrictions, and with maximum commercial benefit of $3,000 (maximum savings of up to $700 per monthly fill). For cash payments, you may be eligible for up to $150 off per monthly fill, up to 13 fills. Maximum annual benefit of $1,950. Offer expires 12/31/2019.*

APPLY FOR A MULTAQ SAVINGS CARD – STEP 1

ACTIVATE YOUR MULTAQ SAVINGS CARD – STEP 1

APPLY FOR A MULTAQ SAVINGS CARD – STEP 2

ACTIVATE YOUR 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.

*Required Field

Please enter your date of birth.

UNDERSTANDING YOUR ROLE IN FILLING YOUR MULTAQ PRESCRIPTION

Set yourself up for success at the pharmacy by knowing the process.

Now that you’ve applied for your savings card, let’s make sure you get your prescription filled.

The number 1 outlined by a circle
Step 1

Receive a written or electronic prescription for MULTAQ.

Receive a written or electronic prescription for MULTAQ.

The number 2 outlined by a circle
Step 2

Activate or apply for your savings card. See above. Activate or apply for your savings card.CLICK HERE.

Activate or apply for your savings card. See above. Activate or apply for your savings card.CLICK HERE.

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Step 3

Take your MULTAQ prescription to the pharmacy, along with your savings card.

Take your MULTAQ prescription to the pharmacy, along with your savings card.

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Step 4

Ask for MULTAQ by name when at your pharmacy.

Ask for MULTAQ by name when at your pharmacy.

The number 1 outlined by a circle
Step 1

Take your activated savings card and your prescription to the pharmacy.
- If you don’t have a prescription for MULTAQ, speak with your doctor

Take your activated savings card and your prescription to the pharmacy.
- If you don’t have a prescription for MULTAQ, speak with your doctor

The number 2 outlined by a circle
Step 2

Ask for MULTAQ by name.
- Remind your pharmacist that there is no generic for MULTAQ

Ask for MULTAQ by name.
- Remind your pharmacist that there is no generic for MULTAQ

BE AWARE: Let your pharmacist know that there is no generic for MULTAQ. Be your own advocate and make sure you talk to your pharmacist to reduce your out-of-pocket costs.

TERMS AND CONDITIONS

* Eligible commercially insured patients may receive a savings of up to $700 per monthly fill, up to 13 fills. Maximum annual benefit of $3,000. Eligible cash patients may receive a savings of up to $150 per monthly fill, up to 13 fills. Maximum annual benefit of $1,950. Sanofi U.S. reserves the right to rescind, revoke, or amend this offer without notice. Certain restrictions apply. See details on savings card. Expires: 12/31/2019.

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. Important to note that if you have an Affordable Care (Health Care Exchange) plan, you may still be qualified to receive and use this savings card. Also, if you have a Federal Employee Health Benefits (FEHB) plan with commercial/private insurance, you may be qualified to receive and use this savings card. This program is not valid where prohibited by law.