Eligibility Requirements

• This rebate cannot be used if any part of your prescription is covered by:
  • any federal or state healthcare program (Medicare, Medicaid, VA, TriCARE, etc.), including a state medical or pharmaceutical assistance program,
  • the Medicare Prescription Drug Program (Part D), or if you are currently in the coverage gap,
  • insurance that is paying the entire cost of the prescription, or
  • an insurer or other Third Party Payor in Massachusetts.

Terms & Conditions

• You must meet Eligibility Requirements.
• You agree to report your use of this rebate to any Third Party that reimburses you or pays for any part of the prescription price.
• You additionally agree that you will not submit the cost of any portion of the product dispensed pursuant to this rebate to a federal or state healthcare program for purposes of counting it toward your out-of-pocket expenses (such as TrOOP under Medicare Part D).
• The amount of this rebate is not to exceed $50 or your co-pay amount, whichever is less.
• This rebate is not valid with any other program, discount, or incentive involving ACTOS.
• Offer is invalid for submissions postmarked later than eight weeks from the dispense date on the original receipt.
• This offer may be rescinded, revoked, or amended without notice.
• No reproductions.
• This rebate is void where prohibited by law, taxed, or restricted.
• Limit one rebate per purchase. Cash value of 1/100 of 1¢. For questions about this rebate, call the Customer Service Center at (888) 838-9866.

Save on prescriptions with the Together Rx Access® Program*

• Together Rx Access® is a prescription savings program that offers a free, easy way to save on prescription medications. Most cardholders save 25% to 40% on brand-name medicines and also save on a wide range of generic medications.^†
• To learn more about how to apply, eligibility requirements, and other information about the program, call 1-800-444-4106 or visit TogetherRxAccess.com.

*Eligibility requirements include household income, not being eligible for Medicare, not having prescription drug coverage (public or private), and being a legal resident of the United States or Puerto Rico. For more information regarding eligibility, contact Together Rx Access at 1-800-444-4106.

†Each cardholder’s savings depend on such factors as the particular drug purchased, amount purchased, and pharmacy where purchased. Participating companies independently set the level of savings offered and the products included in the program. Those decisions are subject to change.

Patient Assistance Program

• The Patient Assistance Program gives patients who would otherwise find it financially difficult to receive type 2 diabetes treatment access to a free year of ACTOS therapy.
  • You must meet the required income level, not have medical insurance coverage for prescriptions and/or be ineligible for government or private programs, and must be a legal resident of the United States.
  • If you have Medicare Part D coverage, you may also be eligible to receive assistance.
• For information on how to enroll, call 1-800-830-9159.