WELCOME TO THE EDARBI® (AZILSARTAN MEDOXOMIL) AND EDARBYCLOR® (AZILSARTAN MEDOXOMIL/CHLORTHALIDONE) COPAY SAVINGS CARD PROGRAM

FOR PATIENTS: If your copay for EDARBI or EDARBYCLOR exceeds $15 (commercially insured patients) present this card to the pharmacist for an instant rebate.* Benefit limitations apply. Patient is responsible for the remaining balance after benefit limits are reached. For questions regarding your eligibility or benefits, or if you wish to discontinue your participation, call (877) 264-2440 (8:00 a.m.-8:00 p.m. ET, Monday-Friday).

FOR PHARMACISTS: Benefit limitations apply.* Additional program details are available at www.edarbi.com. When you use this card, you are certifying that you have not submitted and will not submit a claim for reimbursement under any federal, state, or other governmental programs for this prescription. By redeeming this coupon, you agree that you understand and will abide by the terms and conditions of this offer, posted at www.mckesson.com/mprstnc.

*Must meet eligibility requirements. Azurity Pharmaceuticals, Inc. reserves the right to rescind, revoke, or amend this offer without notice.
See Terms and Conditions.

All personal information will be kept confidential and will not be shared with any parties other than
Azurity Pharmaceuticals, Inc. and its designated partners.

Terms and Conditions

  • Submit transaction to McKesson Corporation using BIN #610524.
  • Patient not eligible if prescriptions are paid in part or full by any state or federally funded programs, including but not limited to, Medicare or Medicaid, Medigap, VA, DOD, or TriCare. This program is not valid where prohibited by law; you will otherwise comply with the terms above. Not intended for distribution to healthcare providers in Vermont.
  • If primary coverage exists, input card information as secondary coverage and transmit using the coordination of benefits (COB) segment of the National Council for Prescription Drug Programs (NCPDP) transaction. Applicable discounts will be displayed in the transaction response.
  • Acceptance of this card and your submission of claims for the EDARBI and EDARBYCLOR Savings Card program are subject to the EDARBI and EDARBYCLOR Savings Card program Terms and Conditions posted at www.mckesson.com/mprstnc.
    • LoyaltyScript® is not an insurance card.
  • For questions regarding setup, claim transmission, patient eligibility, or other issues, call (877) 264-2440 (8:00 a.m.-8:00 p.m. ET, Monday-Friday).

Request Copay Savings Card

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WELCOME TO THE SAVINGS PROGRAM!

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