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By using this coupon, you acknowledge that you currently meet the eligibility criteria and will comply with the Terms and Conditions described below:
This coupon is not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid,
Medicare or other federal or state healthcare programs, including any state prescription drug assistance programs and
the Government Health Insurance Plan available in Puerto Rico (formerly known as "La Reforma de Salud"). This coupon is
not valid for prescriptions that are eligible to be reimbursed by private insurance plans or other health or pharmacy
benefit programs which reimburse you for the entire cost of your prescription drugs. You will receive $25 or the amount
of the co-pay. If your co-pay is less than $25, that amount will be applied to your co-pay. You must deduct the value of
this coupon from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf.
Coupon cannot be combined with any other rebate/coupon, free trial or similar offer for the specified prescription.
Coupon will be accepted only at participating pharmacies.No membership fees are associated with this coupon. This coupon is not health insurance. Offer good only in the U.S. and Puerto Rico. Coupon is limited to 1 person during this offering period and is not transferable. Pfizer reserves the right to rescind, revoke or amend this offer without notice. Offer expires 12/31/15.
For patients with PREMARIN coverage: Use your customers prescription insurance for the primary claim. Process a Coordination of Benefits claim to PDM under BIN#: 610020 as the secondary claim. For patients without PREMARIN coverage: Process a primary claim to PDM under BIN#: 610020.
Download the PREMARIN® (conjugated estrogens tablets, USP) Savings Card and pay as little as $15* per prescription, up to 12 times in a calendar year.
By participating in the PREMARIN® (conjugated estrogens tablets, USP) Pay As Little As $15 Co-pay Card Program, you acknowledge that you currently meet the eligibility criteria and will comply with the Terms and Conditions described below:
For reimbursement when using a nonparticipating pharmacy/mail order: Pay for PREMARIN prescription and mail copy of original pharmacy receipt (cash register receipt NOT valid) with product name, date, and amount circled to: PREMARIN $15 Co-pay Card, 14001 Weston Parkway, Suite 103, Cary, NC 27513. Be sure to include a copy of the front of your $15 Co-pay Card, your name, and mailing address.
For help with the PREMARIN $15 Co-pay Card, call 1-866-410-3700, or write: PREMARIN $15 Co-pay Card, 14001 Weston Parkway, Suite 103, Cary, NC 27513. Be sure to include your name and mailing address.