For U.S. Residents Only

Multaq Savings Card
Program

YOU MAY QUALIFY FOR AS LOW AS $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 to pay as low as $0 co-pay on each of your next 13 MULTAQ fills with no income restrictions. Maximum benefits apply. See terms and conditions here.*

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.

The number 4 outlined by a circle
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

*Offer only available to eligible patients with commercial insurance not funded through a government healthcare program or to patients paying cash. 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. Subject to an annual cap of $3,000 for commercially insured patients and an annual cap of $1,950 for patients paying cash. Sanofi U.S. reserves the right to rescind, revoke, or amend this offer without notice. Void where prohibited by law.