Luxamend Savings Card2018-10-30T16:57:50+00:00

RxBIN: 601341
RxPCN: OHCP
RxGROUP: OH6702021
RxID:

INVALID ID
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SUF: 01

Good for a maximum of 12 prescription fills. * See below for program rules and eligibility requirements.

Patient Instructions

Insured Patients: Present this copay card with your prescription for Luxamend and pay
the first $20 of your out-of-pocket expense. Restrictions and maximum benefits may apply.
Insured Patients Whose Insurance Does Not Cover Luxamend and Uninsured
Patients:
Present this card with your prescription for Luxamend and pay the first $50 of
your out-of-pocket expense. Actual payment will depend on individual insurance coverage.
Restrictions and maximum benefits may apply. Cardholders with questions, please
call 1-800-364-4767.

Eligibility Criteria

This offer is only good with a prescription of Luxamend. This offer is not valid for
prescriptions reimbursed by Medicare, Medicaid, federal or state programs (including any state
prescription drug programs). Offer good only in the United States and can not be redeemed
at government subsidized pharmacies. The selling, purchasing, trading or counterfeiting of
this offer is prohibited by law. Not valid with any other offer. Maximum reimbursement limits
apply. Void where prohibited. Good for a maximum of 12 prescription fills.

Pharmacist Instructions

This card must be accompanied by a valid prescription for Luxamend. Please submit the
copay authorized by the patient’s primary insurance as a secondary transaction to IMS Health.
Pharmacists with questions, please call IMS Health at 1-800-364-4767.

This card is the property of Journey Medical Corporation and IMS Health and must be returned
upon request. Not valid for patients covered under Medicaid, Medicare, or similar state or
federal programs. Card is limited to one per person and is not transferable. This card is not
health insurance. This offer may be changed or discontinued at any time without notice.