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LIPITOR SAVINGS CARD TERMS AND CONDITIONS

By using the LIPITOR Savings Offer, 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 LIPITOR 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 LIPITOR under this program or you use commercial/private insurance and your out-of-pocket expense for a 30-day supply of brand-name LIPITOR is $130 or more. In addition:

a) Medicare Part D patients may participate in this Savings Offer Program, but cannot use any part of their Medicare Part D prescription benefit for LIPITOR during the term of this offer.

b) Out-of-pocket expenditures under this Savings Offer Program cannot be applied towards a patient’s Medicare Part D true out of pocket (TrOOP) expenses.

c) Patients participating in this category cannot seek reimbursement for a purchase of LIPITOR from any third party insurance entity during the term of this offer.

This Savings Offer is not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare, Tricare 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 Savings Offer cannot be combined with any other rebate/coupon, free trial, discount, prescription savings card, or similar offer for the specified prescription.

The Savings Offer will be accepted only at participating pharmacies.

This Savings Offer is not health insurance.

Offer valid only in the U.S. and Puerto Rico, but not for Massachusetts residents.

This coupon is not valid where prohibited by law.

The Savings Offer 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 Savings Offer.

Pfizer reserves the right to rescind, revoke or amend the Savings Offer Program without notice at any time.

Savings Offer Program expires December 31, 2019.

No membership fees.

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:

LIPITOR Savings Card
2250 Perimeter Park Drive
Suite 300
Morrisville, NC 27560

Be sure to include a copy of the front of your Savings Card, your name and mailing address.

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