Please click here for full Prescribing Information,
including Boxed Warning, for Fetzima.
By activating your Fetzima Savings Card, you certify that you are not enrolled in a federal- or state-funded prescription drug benefit program, such as Medicare, Medicaid, or any private indemnity or HMO insurance plan that reimburses you for the entire cost of your prescription drugs. You also certify that you are not Medicare-eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees. You further certify that should you begin receiving prescription benefits from one of these types of programs at any time, you will no longer participate in this savings program.
Program Terms, Conditions and Eligibility Criteria
- This offer is valid only for patients 18 years of age or older and is good for use only with a valid prescription for FETZIMA® (levomilnacipran) extended-release capsules 20 mg, 40 mg, 80 mg and/or 120 mg capsules or one Titration Pack at the time the prescription is filled by the pharmacist and dispensed to the patient.
- Maximum savings limit applies. Depending on insurance coverage, most eligible patients may pay as little as $40 per 30-day supply for each of up to twelve (12) prescription fills OR may pay as little as $40 per 90-day supply for each of up to four (4) prescription fills. Check with your pharmacist for your discount. Patient outof-pocket expense may vary.
- This card is not valid for use by patients enrolled in Medicare, Medicaid, or other federal or state programs (including any state pharmaceutical assistance programs), or private indemnity or HMO insurance plans that reimburse you for the entire cost of your prescription drugs. Patients may not use this card if they are Medicare-eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees. This offer is not valid for cash-paying patients.
- This card is valid for up to twelve (12) prescription fills for a 30-day supply, up to six (6) prescription fills for a 60-day supply, or for up to four (4) prescription fills for a 90-day supply. Offer applies only to prescriptions filled before the program expires on 12/31/20.
- Allergan reserves the right to rescind, revoke, or amend this offer without notice.
- Offer good only in the USA, including Puerto Rico, at participating retail pharmacies.
- Void where prohibited by law, taxed, or restricted.
- This card is not transferable. The selling, purchasing, trading, or counterfeiting of this card is prohibited by law.
- This card has no cash value and may not be used in combination with any other discount, coupon, rebate, free trial, or similar offer for the specified prescription.
- This offer is not health insurance.
- This card expires December 31, 2020.
- By redeeming this card, you acknowledge that you are an eligible patient and that you understand and agree to comply with the terms and conditions of this offer.
For questions about the program, including savings on mail-order prescriptions, please call 1.855.439.2801.