Lyrica Co Pay Card
Instant Co-Pay Assistance Program ... ID# XXXXXXXXX Valued at over $400 for up to 12 redemptions Instant Savings Card
• 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,
Please call the Member Services number on your ID card if you have additional questions about your prescription benefits. ... * Lyrica* Nexium*^ Norditropin* Nutropin, ...
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 ...
... (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.
Pay attention to any changes, especially sudden changes, in mood, behaviors, thoughts, or feelings. ...
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.
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 ...
... 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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