Lyrica Co Pay Card

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Instant Co-Pay Assistance Program - Do you have migraines ...

Instant Co-Pay Assistance Program ... ID# XXXXXXXXX Valued at over $400 for up to 12 redemptions Instant Savings Card

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Program - Patients must read this and sign the acknowledgment ...

• This offer may not be combined with any other coupon, discount, prescription savings card, free trial, or other offer • This program is not available to individuals enrolled in federal or state subsidized healthcare programs that cover prescription drugs,

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Prescription Program

Please call the Member Services number on your ID card if you have additional questions about your prescription benefits. ... * Lyrica* Nexium*^ Norditropin* Nutropin, ...

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MEDICAID PRIOR AUTHORIZATION CONTACT LIST

Rev. 10/23/2003 MEDICAID PRIOR AUTHORIZATION CONTACT LIST Prior Authorization Help Desk (Unisys) 1-800-807-1273 Department for Medicaid Services - Customer Services Branch 502-564-2687 Appeals/Denials Healthcare Review Corporation (Requests for appeal of a medical denial) 877-735-1326 502-426 ...

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ABILIFY PATIENT ASSISTANCE PROGRAM P.O. Box 8309 Somerville ...

... (Please attach copy of Medicaid card) Yes No Yes No Medicare D Have you applied for Medicaid in the past and been denied? ... Medicare or any other public or private program and I have insufficient financial resources to pay for the prescribed therapy.

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HIGHLIGHTS OF PRESCRIBING INFORMATION

Pay attention to any changes, especially sudden changes, in mood, behaviors, thoughts, or feelings. ...

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PRECAUTIONS General

AMRIX ® Rx Only (Cyclobenzaprine Hydrochloride Extended-Release Capsules) DESCRIPTION AMRIX ® (Cyclobenzaprine Hydrochloride Extended-Release Capsules) is a skeletal muscle relaxant which relieves muscle spasm of local origin without interfering with muscle function.

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Pfizer Zero Copay Prescription Drug List

druglist2011_august11.qxd. Allergy, Severe EpiPen EpiPen Jr. Alzheimer's Disease Aricept Anti-Asthmatic Intal Tilade Anticoagulants Fragmin Anticonvulsants Celontin Cerebyx Dilantin Lyrica Neurontin Zarontin Antidepressants Effexor Effexor XR Pristiq Antidiarrheals Lomotil Antifungal Diflucan ...

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Patient Assistance Programs

... lyrica, neurontin and zarontin Pfizer, Inc. www.dilantin.com or www.pfizer.com ATTN: Dilantin PO Box 2222 Morrisville, ... $4 co-pay Card UCB Patient Assistance Program www.rxassist.org ...

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