Sunovion Treatment Options

ALVESCO® (CICLESONIDE) SAVINGS PROGRAM

Register for the ALVESCO (ciclesonide) Savings Program, and you may reduce your co-pays to as little as $17* on each ALVESCO prescription fill.

Just present your savings card at the pharmacy for a co-pay reduction of up to $75.* That could total up to $900 of savings every year!

* Most insured patients will pay no more than $17 monthly with a maximum benefit of $75 per fill. Restrictions apply and co-pay amounts may vary. See full program rules and eligibility.



Your ALVESCO (ciclesonide) Savings Program card is good for up to 12 fills or refills per calendar year. Each time you use your card to refill your ALVESCO prescription your co-pay will be reduced to $17.*

No. Your card "resets" on January 1st of each year, allowing you a reduced co-pay on up to 12 prescription fills* for the upcoming year.

If you're refilling at the same pharmacy where you've used your card before, they should have your information on file and your co-pay will automatically be reduced.* If you need another co-pay card for a refill at a different pharmacy, you may reprint your co-pay card, or call 1-855-834-3461 between the hours of 8:00 am and 8:00 pm Eastern Time, Monday through Friday, and we'll send you a new card in the mail.

Check with your mail-order pharmacy to see if they accept co-pay cards such as the ALVESCO (ciclesonide) Savings Program card.* If they do, all you need to do is submit a photocopy of your co-pay card along with your prescription and insurance information.

For mail-order pharmacies that do not accept co-pay cards, we will reimburse you for the difference so you are still getting ALVESCO for $17. Visit www.patientrebateonline.com for more information.

Yes. If you're unable to use your ALVESCO (ciclesonide) Savings Program card* at the time of purchase, visit www.patientrebateonline.com. Click on "Get Started", and then follow the instructions to fill out and print the Patient Rebate form. You must attach your original pharmacy receipt to the form and mail them both back to us. If you have any questions or problems while you're using the site, you can use our "Click to Talk" feature, and someone will call you back to assist you.

It takes about 30 minutes for your membership to be processed after you sign up or activate your card, either online or by phone. After 30 minutes, you will be able to get your discount on ALVESCO (ciclesonide) Inhalation Aerosol.*

No. Each person must be enrolled in the program and have his or her own co-pay card.* A parent or guardian must enroll in the ALVESCO (ciclesonide) Savings Program on behalf of a patient under 18 years of age. To get the discount on both prescriptions, you would need to present both your co-pay card and your child's co-pay card at the pharmacy.

 

*Program Rules – Patient Eligibility, Terms, and Conditions

Valid only for qualified customers with a valid prescription for ALVESCO® (ciclesonide) Inhalation Aerosol. No substitutions permitted.

A parent or guardian must enroll in the ALVESCO (ciclesonide) Savings Program on behalf of a patient under 18 years of age.

Not valid for prescriptions covered or paid for by Medicare (including true out-of-pocket expenses under Medicare Part D), Medicaid, or any other federal or state healthcare programs, such as state pharmaceutical assistance programs.

Not valid for patients who are Medicare eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees (i.e., you are eligible for Medicare Part D but receive a prescription drug benefit through a former employer).

Your discount with the ALVESCO (ciclesonide) Savings Program card is valid to reduce your co-pay to $17 with a maximum reduction of $75 per prescription. Discount available on up to twelve (12) prescription fills for ALVESCO per calendar year.

Your acceptance of this offer must be consistent with the terms of any drug benefit provided by a health insurer, health plan, or other third-party payor, and you agree to report acceptance of this offer to your health insurer, health plan, or third-party payor as may be required.

Offer limited to one card per person, and may not be used with any other discount, coupon, or offer.

Only an original ALVESCO (ciclesonide) Savings Program card or web-generated paper card will be accepted and must be presented to your pharmacist at the time you have the prescription filled—not valid if reproduced.

Offer valid only in the United States. Void where prohibited by law, taxed, or restricted.

Sunovion Pharmaceuticals Inc. reserves the right to change or discontinue this offer at any time without notice.

By participating in this program, you the patient certify that (a) you have read the above terms; (b) you are not reimbursed, nor will you submit a claim for reimbursement, nor will you seek to have any portion of this prescription counted toward your out-of-pocket costs (eg, TrOOP) under any federal, state, or private programs for this or other prescriptions for ALVESCO to which this offer will apply; and (c) you will otherwise comply with the terms above.

Using mail-order pharmacies

Check with your mail-order pharmacy to see if they accept loyalty cards such as the ALVESCO Savings Program card (most of them do). If they do, all you need to do is submit a photocopy of your card along with your prescription and insurance card information.

For mail-order pharmacies that do not accept loyalty cards, we will reimburse you $75. Please call 1-855-834-3458 or visit http://www.patientrebateonline.com to request a form that you may fill out and return to us, along with a copy of your receipt. We will then issue you a check.