This card is good for use only with a valid prescription for Enstilar® (calcipotriene and betamethasone dipropionate) Foam 0.005%/0.064%, Picato® (ingenol mebutate) gel 0.015%, 0.05%, Finacea® (azelaic acid) Foam 15%, or Desonate® (desonide) Gel 0.05%.
This card is valid for up to 12 prescription fills per calendar year, up to a maximum benefit of $6000 per year for Enstilar®, or Picato®, up to a maximum benefit of $1200 per year for Finacea Foam® and up to a maximum benefit of $2400 per year for Desonate®.
For patients with commercial health insurance, this card may reduce out-of-pocket expenses.
Offer good only in the USA at participating pharmacies.
Original card must be presented to the pharmacist at the time the prescription is filled. Not valid if reproduced.
Only one card per patient.
The selling, purchasing, trading, or counterfeiting of this card is prohibited by the law.
Card is not transferable.
You must be 18 years of age or older to use this card. If you are under 18, a legal guardian over 18 years of age may access this program on your behalf where permitted by, and consistent with, additional restrictions imposed by law (and subject to any additional age restrictions that relate to each product).
This card is not health insurance.
You are responsible for the use of this card and for complying with reporting obligations, if any, of your insurance plan.
Patient is not eligible to participate in the program or use the card if enrolled in or eligible for any state or federally funded programs, including, but not limited to, Medicare (including Medicare Part D), Medicaid, Medigap, VA, DOD, TriCare, or CHIP.
Offer void where prohibited by law, taxed, or restricted.
Not valid in combination with any other offers, discounts, or programs.
Card has no cash value.
LEO Pharma Inc. reserves the right to rescind, revoke, or amend this offer without notice.
You understand and agree to the terms and conditions as set forth above.