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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.

The number 3 outlined by a circle
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.

IMPORTANT SAFETY INFORMATION FOR MULTAQ® (dronedarone)

What is the most important safety information I should know about MULTAQ?

Do not take MULTAQ if you have symptoms of heart failure that recently worsened and you were hospitalized, or if you have severe heart failure. MULTAQ doubles your risk of dying if you have these conditions.

Do not take MULTAQ if you have a type of atrial fibrillation (AFib) called permanent AFib. You should not take MULTAQ if you are in AFib and your doctor is not planning to change you back into normal rhythm. People with permanent AFib who take MULTAQ have a higher risk of death, stroke, and needing to be treated in a hospital for heart failure.

MULTAQ may cause liver problems, including life-threatening liver failure. Call your doctor right away if you are taking MULTAQ and develop any of these signs and symptoms of liver problems: loss of appetite; nausea; vomiting; fever; feeling unwell; unusual tiredness; itching; yellowing of the skin or the whites of the eyes; unusual darkening of the urine; right upper stomach area pain or discomfort.

When should I call the doctor?

Call your doctor right away if you're taking MULTAQ and have any signs and symptoms of heart failure. These may include shortness of breath or wheezing at rest; wheezing, chest tightness, or coughing up frothy sputum at rest, nighttime, or after minor exercise; trouble sleeping or waking up at night or using more pillows to prop yourself at night because of breathing problems; weight gain; or foot or leg swelling.

Call your doctor right away if you notice that your heartbeat or pulse is irregular. This is a sign that you are in AFib.

Call your doctor if you develop shortness of breath or a dry cough during treatment with MULTAQ.

Call your doctor if you experience an allergic reaction, such as itchy rash, low blood pressure, or rapid swelling of the throat or skin, especially around the lips or eyes.

Who else shouldn't take MULTAQ?

You should not take MULTAQ if you are allergic to dronedarone or any of the other ingredients in MULTAQ.

You should not take MULTAQ if you have severe liver problems or if you had liver or lung problems after using amiodarone.

You should not take MULTAQ if you have a certain type of heart problem called heart block, and you do not have an implanted pacemaker.

You should not take MULTAQ if you are breastfeeding, pregnant, or plan to become pregnant as it is not known if it may pass to or harm your baby. Women who may become pregnant should use effective birth control while taking MULTAQ. Talk to your doctor about the best birth control methods for you.

Are there any medications I should avoid while taking MULTAQ?

MULTAQ can interact with certain medications. Do not use the following medications with MULTAQ:

Are there other medicines that would be harmful when taken with MULTAQ?

The following medicines can lead to a dangerous abnormal heart rhythm if taken with MULTAQ:

  • Phenothiazines
  • Tricyclic antidepressants
  • Certain antibiotics
  • Certain medicines used to treat an abnormal heart rhythm or fast heartbeat

What are possible serious side effects from taking MULTAQ?

MULTAQ may cause serious side effects including slowed heartbeat, inflammation of the lungs (including scarring and thickening), low potassium and magnesium levels in your blood, and changes in kidney function blood tests.

What are the most common side effects?

The most common side effects when taking MULTAQ include stomach problems such as diarrhea, nausea, vomiting, stomach area pain, and indigestion; feeling tired and weak; skin problems such as redness, rash, and itching. Tell your doctor about any side effect that bothers you or that does not go away.

Are there other things I should avoid while taking MULTAQ?

Do not drink grapefruit juice while taking MULTAQ, as this can increase the likelihood that you will have a side effect of MULTAQ.

What else should I tell my doctor?

Tell your doctor about all medications, vitamins, and herbal remedies (including St. John's wort) you take to help avoid serious drug interactions.

Is it OK to take a diuretic ("water pill") while on MULTAQ?

Your potassium levels should be within the normal range prior to and while taking MULTAQ. Tell your doctor about any diuretic medications ("water pills") you are taking as some can lower the level of potassium or magnesium in your blood.

Will I need any tests while I'm on MULTAQ?

Your doctor will monitor your heart rhythm regularly to make sure your heartbeat keeps a normal rhythm. Your doctor may perform certain tests, such as heart exams and blood tests, while you're taking MULTAQ.

Remember, your doctor is the single best source of information regarding your health. Please consult your doctor if you have any questions about your health or your medicine.

If you are a patient experiencing problems with a Sanofi U.S. product, please contact Sanofi U.S. at 1-800-633-1610.

The health information contained herein is provided for general educational purposes only. Your healthcare professional is the single best source of information regarding your health. Please consult your healthcare professional if you have any questions about your health or treatment.

If you are a patient experiencing problems with a Sanofi US product, please contact Sanofi US at .

The health information contained herein is provided for general educational purposes only. Your healthcare professional is the single best source of information regarding your health. Please consult your healthcare professional if you have any questions about your health or treatment.

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SAUS.DRO.19.03.1838c Last Updated: July 2019

IMPORTANT SAFETY INFORMATION FOR MULTAQ® (dronedarone)

What is the most important safety information I should know about MULTAQ?

Do not take MULTAQ if you have symptoms of heart failure that recently worsened and you were hospitalized, or if you have severe heart failure. MULTAQ doubles your risk of dying if you have these conditions.