•  Eligible patients who present the Ryzolt^® Prescription Savings Card with a valid prescription for Ryzolt^® receive up to $35 off out-of-pocket expenses for each eligible Ryzolt^® prescription during the program period (expiration 12/31/2011) after the patient pays an initial out-of-pocket payment of $10
•  The Prescription Savings Card can only be used every 24 days and only when accompanied by a valid prescription for Ryzolt^®
•  Once activated, the card is retained by the patient and can only be used by the same patient

Eligibility Criteria/Restrictions: Prescription savings offer not valid for prescriptions covered in whole or in part by Medicaid/Medicare (including the coverage gap), government-funded health programs, states that have an “all payer” antikickback law, or private indemnity or HMO insurance plans which reimburse you for the entire cost of your prescription drugs. This offer is valid in Massachusetts for cash-paying patients only (i.e., those who do not have any prescription coverage). This offer is only good in the U.S. at participating pharmacies, cannot be redeemed at government-subsidized clinics, and is not valid if prohibited by any state or local laws

Limit one Prescription Savings Card per patient.

Click here to read Full Prescribing Information

Pharmacist Instructions:

• Therapy First has been authorized to reimburse you up to $35 after the patient pays for the first $10 out-of-pocket expense on each eligible Ryzolt^® Prescription. Savings Card is good for use with all eligible Ryzolt^® prescriptions throughout the program period (program expires 12/31/2011).

• Please read Eligibility Criteria/Restrictions.

• Savings Card can only be used once every 24 days and only when accompanied by a prescription for branded Ryzolt^®. For reimbursement please follow instructions below.

• For Patient Paying Cash: Please submit this claim to Therapy First. A valid Other Coverage Code is required. The patient pay amount will be reduced by up to $35 and you will receive this in your next reimbursement from Therapy First plus a handling fee.

• For a Patient paying via an Authorized Third Party: Submit the claim to the Primary Third Party Payer first, then submit the balance due to Therapy First as a Secondary Payer as a co-pay –only billing,using Other Coverage Code. The pay amount will be reduced by up to $35 after the patient’s $10 out-of-pocket payment, and you will receive this in your next reimbursement from Therapy First plus a handling fee.

• For any questions regarding online processing, please call the Help Desk at 1-800-422-5604, 9:00am-5:00pm EST Mon.–Fri.

• Purdue Pharma L.P. reserves the right to rescind, revoke, or amend this offer without notice.

• NO PHOTOCOPIES ACCEPTED

Click here to read Full Prescribing Information