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XANAX SAVINGS CARD TERMS AND CONDITIONS

By participating in the XANAX Savings Offer Program, you acknowledge that you currently meet the eligibility criteria and will comply with the terms and conditions described below:

  • This Savings Offer is not valid for prescriptions that are reimbursed, in whole or in part, by Medicaid, Medicare, TRICARE, Veterans Affairs healthcare, or any other federal or state healthcare program (including any state prescription drug assistance program), or the Government Health Insurance Plan available in Puerto Rico (formerly known as “La Reforma de Salud”)
  • The value of this Savings Offer is limited to $125 per use or the amount of your co-pay, whichever is less
  • This Savings Offer is not valid when the entire cost of your prescription drug is eligible to be reimbursed by your private insurance plans or other health or pharmacy benefit programs
  • You must deduct the savings received under this program from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf
  • Eligible patients may pay a minimum of $4 per monthly prescription fill. By using this Savings Offer, eligible patients may receive a savings of up to $125 per fill off their co-pay or out-of-pocket costs. This Savings Offer is available for a maximum savings of $1,500 per year ($125 per month x 12 months). This Savings Offer may limit your prescription cost to $4, subject to a $125 maximum monthly benefit. Thus, if your co-pay or out-of-pocket cost is more than $125, you will save $125 off of your co-pay or total out-of-pocket costs. [Example: If your co-pay or out-of-pocket costs are $150, you will pay $25 ($150 – $125 = $25).] If your co-pay or out-of-pocket costs are no more than $125, you pay $4. For a mail-order 3-month prescription, your total maximum savings may be $375 ($125 x 3)
  • You must be 18 years of age or older to redeem this Savings Offer
  • Patients who are enrolled in Medicare, Medicaid, or another state or federal healthcare program may use this Savings Offer if paying for the prescription covered by this Savings Offer outside of their government insurance benefit, and no claim is submitted to Medicare, Medicaid, or any federal or state healthcare program. Such patients must not apply any out-of-pocket expenses incurred using this Savings Offer toward any government insurance benefit out-of-pocket spending calculations, such as Medicare Part D true out-of-pocket (TrOOP) costs
  • You are responsible for reporting use of this Savings Offer to any private insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using this Savings Offer, as may be required. You should not use this Savings Offer if your insurer or health plan prohibits use of manufacturer Savings Offers
  • This Savings Offer is not valid (i) for Massachusetts residents or (ii) for California residents whose prescriptions are covered, in whole or in part, by third-party insurance
  • This Savings Offer is not valid where prohibited by law
  • This Savings Offer cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription
  • This Savings Offer will be accepted only at participating pharmacies
  • This Savings Offer is not health insurance
  • This Savings Offer is good only in the U.S. and Puerto Rico
  • This Savings Offer is limited to 1 per person during this offering period and is not transferable
  • No other purchase is necessary
  • A Savings Offer may not be redeemed more than once per 30 days per patient
  • Data related to your redemption of this Savings Offer may be collected, analyzed, and shared with Pfizer for market research and other purposes related to assessing Pfizer’s programs. Data shared with Pfizer will be aggregated and de-identified; it will be combined with data related to other Savings Offer redemptions and will not identify you
  • Pfizer reserves the right to rescind, revoke, or amend the program without notice
  • No membership fees. This Savings Offer and Program expire on 12/31/2021
  • For questions about this Savings Offer, please call 1-855-854-4535, visit XANAX.com, or write to: Pfizer Inc., 235 E 42nd Street, New York, NY 10017

For reimbursement when using a mail-order pharmacy, please submit the following via mail:

  • A copy of your XANAX Savings Card, your original proof of purchase (original pharmacy receipt, cash register receipt NOT valid), with the pharmacy name, product name, prescription numbers, NDC number, date filled, quantity, and price circled, a photocopy of the front and back of your insurance card, your date of birth, name, and mailing address
  • Mail all of the information to: XANAX Claims Processing Department, PO Box 1785, New York, NY 10156

Please allow 6-8 weeks to receive your reimbursement. Reimbursement requests must be postmarked within 4 weeks of fill date.

 
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