Terms and Conditions
- Co-pay cards are 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"]).
- Co-pay cards are not valid for prescriptions that are eligible to be reimbursed by private insurance plans or other health or pharmacy benefit programs that reimburse you for the entire cost of your prescription drugs.
- Patients must be 18 or older.
- By using a co-pay card, a patient may pay only $10 per prescription. Savings provided by each co-pay card are limited to $100 per month. Each co-pay card may be used once per month for twelve (12) months. Provided you continue to meet the eligibility criteria, you may be eligible to receive a second co-pay card during the offering.
- Each patient is limited to one active co-pay card at a time during this offering period and the co-pay cards are not transferable.
- You must deduct the value received under this program from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf.
- The co-pay card cannot be combined with any other rebate or coupon, free trial, or similar offer for the specified prescription.
- The co-pay card will be accepted only at participating pharmacies.
- The co-pay card is not health insurance.
- This offer is good only in the United States and Puerto Rico.
- Pfizer reserves the right to rescind, revoke, or amend the co-pay card without notice.
- Offer valid from 4/1/11 to 12/31/13. No membership fees apply.
IMPORTANT SAFETY INFORMATION
All brands are trademarks of their owners.
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RELPAX is available in 20 mg and 40 mg tablets.
RELPAX is available by prescription only.