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TERMS, CONDITIONS, AND ELIGIBILITY CRITERIA

  1. This card is not valid for prescriptions submitted for reimbursement to Medicare, Medicaid, Medigap, VA, DOD, or TriCare, or where prohibited by law; to other federal or state programs (including any state pharmaceutical assistance programs); or to private indemnity or HMO insurance plans that reimburse you for the entire cost of your prescription drugs. Patients may not use this card if Brekiya autoinjector is covered under their Medicare prescription drug plan or if they are Medicare-eligible and enrolled in an employer sponsored health plan or prescription drug benefit program for retirees.
  2. This card is good for use only with a Brekiya autoinjector prescription at the time the prescription is filled by the pharmacist and dispensed to the patient.
  3. Maximum reimbursement limits apply; patient out-of-pocket expenses may vary.
  4. Amneal reserves the right to rescind, revoke, or amend this offer without notice.
  5. Offer good only in the US.
  6. Void if prohibited by law, taxed, or restricted.
  7. The selling, purchasing, trading, or counterfeiting of this card is prohibited by law.

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