You Could Get Your Prescription
FREE* for up to One Year

*Subject to eligibility rules for commercially insured patients, restrictions apply.

 

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FOR ELIGIBLE COMMERCIALLY INSURED PATIENTS

You could get your SYMBICORT prescription filled FREE for up to 12 months—even if you have restrictions on your prescription benefit coverage.*

*ELIGIBILITY

You may be eligible for this offer if you are insured by commercial insurance and your insurance does not cover the full cost of your prescription, or you are not insured and are responsible for the cost of your prescriptions.

Patients who are enrolled in a state or federally funded prescription insurance program are not eligible for this offer. This includes patients enrolled in Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DOD) programs or TriCare, and patients who are Medicare eligible and enrolled in an employer-sponsored group waiver health plan or government-subsidized prescription drug benefit program for retirees.

If you are enrolled in a state or federally funded prescription insurance program, you may not use this savings card even if you elect to be processed as an uninsured (cash-paying) patient.

This offer is not insurance, is restricted to residents of the United States and Puerto Rico, and to patients over 6 years of age subject to label indication. If you use a mail-order pharmacy, please contact your pharmacy provider to confirm if this offer will be accepted.

TERMS OF USE

Eligible commercially insured/covered patients with no restrictions (step-edit, prior authorization, or NDC block) and with a valid prescription for SYMBICORT® (budesonide/formoterol fumarate dihydrate) who present this savings card at participating pharmacies will receive up to 100% off on their out-of-pocket costs for each covered 30-, 60-, or 90-day supply (1-3 inhalers), respectively , up to a maximum savings of $200 per inhaler. If you pay cash for your prescription, or are insured and your insurance does not cover or has a managed care restriction on your prescription (step-edit, prior authorization, or NDC block), you will receive up to $100 in savings on your out-of-pocket costs for each inhaler. This offer is good for 12 uses and each inhaler counts as 1 use. Patient is responsible for applicable taxes, if any. If you have any questions regarding this offer, please call 1-844-798-3617.

Non-transferable, limited to one per person, cannot be combined with any other offer. Void where prohibited by law, taxed, or restricted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer.

AstraZeneca reserves the right to rescind, revoke, or amend this offer, eligibility, and terms of use at any time without notice. This offer is not conditioned on any past, present, or future purchase, including refills. Offer must be presented along with a valid prescription for SYMBICORT at the time of purchase.

If your commercial insurance plan does not cover SYMBICORT, use of this offer permits your health care provider or pharmacy to share limited information with certain AstraZeneca vendors to determine if additional resources may be available to you; and to act on your behalf to initiate any processes that may be necessary to access these resources.

BY USING THIS CARD, YOU AND YOUR PHARMACIST UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

Program managed by ConnectiveRx on behalf of AstraZeneca.

MEDICARE/MEDICAID/UNINSURED PATIENTS

You could get your first SYMBICORT prescription (one inhaler) FREE!* Just present the free prescription offer to your pharmacist along with a valid prescription for SYMBICORT.

*ELIGIBILITY

You may be eligible for this offer if you are insured by commercial insurance and your insurance does not cover the full cost of your prescription, or you are not insured and are responsible for the cost of your prescriptions.

Patients who are enrolled in a state or federally funded prescription insurance program are not eligible for this offer. This includes patients enrolled in Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DOD) programs or TriCare, and patients who are Medicare eligible and enrolled in an employer-sponsored group waiver health plan or government-subsidized prescription drug benefit program for retirees.

If you are enrolled in a state or federally funded prescription insurance program, you may not use this savings card even if you elect to be processed as an uninsured (cash-paying) patient.

This offer is not insurance, is restricted to residents of the United States and Puerto Rico, and to patients over 6 years of age. If you use a mail-order pharmacy, please contact your pharmacy provider to confirm if this offer will be accepted.

TERMS OF USE

Eligible commercially insured patients with a valid prescription for SYMBICORT® (budesonide/formoterol fumarate dihydrate) who present this savings card at participating pharmacies will receive 100% off their out-of-pocket costs for each 30, 60, or 90-day supply (1-3 inhalers), respectively. If you pay cash for your prescription, you will receive up to $100 in savings on your out-of-pocket costs for each prescription. This offer is good for 12 uses and each inhaler counts as 1 use. Patient is responsible for applicable taxes, if any. Card expires on 12/31/18. If you have any questions regarding this offer, please call 1-844-798-3617.

 

Non-transferable, limited to one per person, cannot be combined with any other offer. Void where prohibited by law, taxed or restricted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer.

AstraZeneca reserves the right to rescind, revoke, or amend this offer, eligibility and terms of use at any time without notice. This offer is not conditioned on any past, present or future purchase, including refills. Offer must be presented along with a valid prescription for SYMBICORT at the time of purchase.

If your commercial insurance plan does not cover SYMBICORT, use of this offer permits your healthcare provider or pharmacy to share limited information with certain AstraZeneca vendors to determine if additional resources may be available to you; and to act on your behalf to initiate any processes that may be necessary to access these resources.

BY USING THIS CARD, YOU AND YOUR PHARMACIST UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

Program managed by ConnectiveRx on behalf of AstraZeneca.

AstraZeneca respects your personal health information. The information you provide may be used to send you health-related materials and to develop products, services, and programs. Third parties working on behalf of AstraZeneca may receive information that includes the date that you filled the prescription, the quantity of medication dispensed by your pharmacist, and your savings under the Program. AstraZeneca, or third parties working on our behalf, will not sell or rent personal health information. If in the future you no longer want to receive these materials, please call 1-800-236-9933.

Please visit www.azprivacynotice.com to review our Privacy Notice.

Important Safety Information
Read More
  • SYMBICORT combines an ICS, budesonide and a LABA medicine, formoterol. LABA medicines, such as formoterol, when used alone can increase the risk of hospitalizations and death from asthma problems. When an ICS and LABA are used together, this risk is not significantly increased
  • Do not use SYMBICORT for sudden severe symptoms of COPD or asthma
  • Before you use SYMBICORT, tell your healthcare provider about all of your medical conditions, including if you have heart conditions or high blood pressure, and all the medicines you may be taking. Some patients taking SYMBICORT may experience increased blood pressure, heart rate, or change in heart rhythm
  • Do not use SYMBICORT more often than prescribed. SYMBICORT should be taken as 2 puffs 2 times each day
  • While taking SYMBICORT, do not use another medicine containing a LABA for any reason. Ask your healthcare provider or pharmacist if any of your other medicines are LABA medicines
  • Call your healthcare provider or get medical care right away if:
    • Your breathing problems worsen
    • You need to use your rescue inhaler more often than usual or your rescue inhaler doesn’t work as well at relieving symptoms
  • SYMBICORT may cause serious side effects, including:
    • Using too much of a LABA medicine may cause chest pain, fast and irregular heartbeat, tremor, increased blood pressure, headache or nervousness
    • Fungal infection in your mouth or throat (thrush). Rinse your mouth with water without swallowing after using SYMBICORT to help reduce your chance of getting thrush
    • Pneumonia and other lower respiratory tract infections. People with COPD may have a higher chance of pneumonia and other lung infections. ICS may increase the chance of getting pneumonia. Call your healthcare provider if you notice any of the following symptoms: increase in mucus production or change in color, fever, increased cough, chills, or increased breathing problems
    • Immune system effects and a higher chance for infections. Tell your healthcare provider about any signs of infection such as: fever, body aches, feeling tired, vomiting, pain, chills, or nausea
    • Adrenal insufficiency. This can happen when you stop taking oral corticosteroid medicines and start inhaled corticosteroid medicine
    • Increased wheezing right after taking SYMBICORT. Always have a rescue inhaler with you to treat sudden wheezing
    • Serious allergic reactions including rash, hives, swelling of the face, mouth, and tongue, and breathing problems. Call your healthcare provider or get emergency medical care if you get any symptoms of a serious allergic reaction
    • Lower bone mineral density can happen in people who have a high chance for low bone mineral density (osteoporosis)
    • Slowed growth in children. A child’s growth should be checked regularly while using SYMBICORT
    • Eye problems including glaucoma and cataracts. You should have regular eye exams while using SYMBICORT
    • Swelling of blood vessels. This can happen in people with asthma. Tell your healthcare provider right away if you have: a feeling of pins and needles or numbness of arms or legs, rash, flu like symptoms, or pain and swelling of the sinuses
    • Decreases in blood potassium levels (hypokalemia)
    • Increases in blood sugar levels (hyperglycemia)
  • The most common side effects of SYMBICORT include:
    • COPD: throat irritation, thrush in the mouth and throat, bronchitis, sinusitis, and upper respiratory tract infection
    • Asthma: throat irritation, headache, upper respiratory tract infection, throat pain, sinusitis, flu, back pain, nasal congestion, stomach discomfort, vomiting, and thrush in the mouth and throat

Approved Uses

COPD: SYMBICORT 160/4.5 mcg is used long-term to improve symptoms of chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema, for better breathing and fewer flare-ups.

Asthma: SYMBICORT is for the treatment of asthma in patients 6 years and older whose asthma is not well-controlled with an asthma-control medicine such as an inhaled corticosteroid (ICS) or whose asthma warrants treatment with both an ICS and a long-acting beta2-adrenergic agonist (LABA).

SYMBICORT is not used to relieve sudden breathing problems and will not replace a rescue inhaler.

You may report side effects related to AstraZeneca products by clicking here

  • SYMBICORT combines an ICS, budesonide and a LABA medicine, formoterol. LABA medicines, such as formoterol, when used alone can increase the risk of hospitalizations and death from asthma problems. When an ICS and LABA are used together, this risk is not significantly increased
  • Do not use SYMBICORT for sudden severe symptoms of COPD or asthma
  • Before you use SYMBICORT, tell your healthcare provider about all of your medical conditions, including if you have heart conditions or high blood pressure, and all the medicines you may be taking. Some patients taking SYMBICORT may experience increased blood pressure, heart rate, or change in heart rhythm
  • Do not use SYMBICORT more often than prescribed. SYMBICORT should be taken as 2 puffs 2 times each day
  • While taking SYMBICORT, do not use another medicine containing a LABA for any reason. Ask your healthcare provider or pharmacist if any of your other medicines are LABA medicines
  • Call your healthcare provider or get medical care right away if:
    • Your breathing problems worsen
    • You need to use your rescue inhaler more often than usual or your rescue inhaler doesn’t work as well at relieving symptoms
  • SYMBICORT may cause serious side effects, including:
    • Using too much of a LABA medicine may cause chest pain, fast and irregular heartbeat, tremor, increased blood pressure, headache or nervousness
    • Fungal infection in your mouth or throat (thrush). Rinse your mouth with water without swallowing after using SYMBICORT to help reduce your chance of getting thrush
    • Pneumonia and other lower respiratory tract infections. People with COPD may have a higher chance of pneumonia and other lung infections. ICS may increase the chance of getting pneumonia. Call your healthcare provider if you notice any of the following symptoms: increase in mucus production or change in color, fever, increased cough, chills, or increased breathing problems
    • Immune system effects and a higher chance for infections. Tell your healthcare provider about any signs of infection such as: fever, body aches, feeling tired, vomiting, pain, chills, or nausea
    • Adrenal insufficiency. This can happen when you stop taking oral corticosteroid medicines and start inhaled corticosteroid medicine
    • Increased wheezing right after taking SYMBICORT. Always have a rescue inhaler with you to treat sudden wheezing
    • Serious allergic reactions including rash, hives, swelling of the face, mouth, and tongue, and breathing problems. Call your healthcare provider or get emergency medical care if you get any symptoms of a serious allergic reaction
    • Lower bone mineral density can happen in people who have a high chance for low bone mineral density (osteoporosis)
    • Slowed growth in children. A child’s growth should be checked regularly while using SYMBICORT
    • Eye problems including glaucoma and cataracts. You should have regular eye exams while using SYMBICORT
    • Swelling of blood vessels. This can happen in people with asthma. Tell your healthcare provider right away if you have: a feeling of pins and needles or numbness of arms or legs, rash, flu like symptoms, or pain and swelling of the sinuses
    • Decreases in blood potassium levels (hypokalemia)
    • Increases in blood sugar levels (hyperglycemia)
  • The most common side effects of SYMBICORT include:
    • COPD: throat irritation, thrush in the mouth and throat, bronchitis, sinusitis, and upper respiratory tract infection
    • Asthma: throat irritation, headache, upper respiratory tract infection, throat pain, sinusitis, flu, back pain, nasal congestion, stomach discomfort, vomiting, and thrush in the mouth and throat

Approved Uses

COPD: SYMBICORT 160/4.5 mcg is used long-term to improve symptoms of chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema, for better breathing and fewer flare-ups.

Asthma: SYMBICORT is for the treatment of asthma in patients 6 years and older whose asthma is not well-controlled with an asthma-control medicine such as an inhaled corticosteroid (ICS) or whose asthma warrants treatment with both an ICS and a long-acting beta2-adrenergic agonist (LABA).

SYMBICORT is not used to relieve sudden breathing problems and will not replace a rescue inhaler.

You may report side effects related to AstraZeneca products by clicking here

Read More
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