By using the EFFEXOR XR Choice Card (the "Card"), you attest that you meet the eligibility criteria and will comply with the Terms and Conditions described below:
You will pay $4 for a 30-day supply (30 tablets) if: you use commercial/private insurance and your out-of-pocket expense for a 30-day supply of brand-name EFFEXOR XR is $130 or less.
You will pay $30 for a 30-day supply (30 tablets) if: you do not use prescription health coverage to purchase your brand-name EFFEXOR XR under this program or you use commercial/private insurance and your out-of-pocket expense for a 30-day supply of brand-name EFFEXOR XR is $130 or more. In addition:
This offer is not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid 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"]).
For all eligible patients, you can only qualify for up to $2500 of savings per calendar year. After a maximum of $2500, you will pay usual monthly out-of-pocket costs.
This Card cannot be combined with any other rebate/coupon, free trial, discount, prescription savings card, or similar offer for the specified prescription.
The Card will be accepted only at participating pharmacies.
This Card is not health insurance.
Offer valid only in the U.S. and Puerto Rico, but not for Massachusetts residents or where otherwise prohibited by law.
The Card is limited to 1 use per person per month during this offering period and is not transferable. It is illegal to sell, purchase, trade, or counterfeit, or offer to sell, purchase, trade, or counterfeit this Card.
Pfizer reserves the right to rescind, revoke or amend the Card Program without notice at any time.
You must be 18 or older to participate in this Program.
Card Program expires December 31, 2016.
No membership fees.
For questions about this card, please call 1-855-488-0749, visit EffexorXR.com or write to the address below.
For reimbursement when using mail order, mail copy of original pharmacy receipt (cash register receipt NOT valid) with product name, date and amount circled to:
EFFEXOR XR Choice Card
14001 Weston Parkway, Suite 103
Cary, NC 27513-9967
Be sure to include a copy of the front of your Choice Card, your name and mailing address.