Pay as little as $0*

for Teva’s generic

version of 

Adcirca®

(tadalafil) Tablets

DOWNLOAD OFFER

By accepting the offer, I confirm that I do not have Medicare, Medicaid, or other public payer coverage and I am eligible for this offer in accordance with the Terms and Conditions.

*Commercially Insured Patients may pay as little as $0 out-of-pocket for Teva’s ALYQ™ (tadalafil tablets, USP). Teva will pay up to $25 per fill. Please see full Terms and Conditions below.

 

Using your Teva savings card is easy:

  1. Download the digital savings card and present it at your pharmacy
  2. Ask your pharmacist to fill your existing prescription with Teva’s ALYQ™ (tadalafil tablets, USP)

SAVINGS OFFER TERMS AND CONDITIONS

 

Terms and Conditions:  Patients are not eligible if prescriptions are paid for in part or full by any state or federally funded programs, including but not limited to Medicare, Medicaid, Medigap, VA, DOD, TRICARE, or by private health benefit programs which reimburse for the entire cost of prescription drugs. This card is not valid for patients who are Medicare eligible and are enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees (i.e., patients who are eligible for Medicare Part D but receive a prescription drug benefit through a former employer). Cash Discount Cards and other non-insurance plans are not valid as primary under this offer. If the patient is eligible for drug benefits under any such program, the patient cannot use this offer. By redeeming this offer, the patient and the pharmacist acknowledge that the patient is eligible, and the patient and pharmacist understand and agree to comply with the Terms and Conditions of this offer.

 

Patients with managed care restrictions may not be eligible for this offer after the first prescription fill if such managed care restrictions persist.

 

Void if copied, transferred, purchased, altered or traded and where prohibited and restricted by law. This is not an insurance program. Void in the State of California. This offer may not be used with any other discount, coupon or offer. This offer expires on December 31, 2019. This program is managed by ConnectiveRx on behalf of Teva Pharmaceuticals USA, Inc. Teva reserves the right to limit, change or discontinue this offer at any time without notice. If you have any questions regarding your eligibility or benefits, please call 1-844-546-8639.

 

Valid only for Teva’s ALYQ™ (tadalafil tablets, USP), National Drug Code 00093-3334-06

 

To the Patient: This offer is for eligible Commercially Insured Patients only. Patients pay as little as $0 out-of-pocket for Teva’s ALYQ™ (tadalafil tablets, USP). Teva will pay up to $25 of the remaining co-payment or cost-sharing obligation per fill.  This offer must be presented along with your prescription for ALYQ™ (tadalafil tablets, USP) and your primary insurance card to participate in this program. Non-Insured/Cash-Paying Patients are not eligible for this offer.

 

To the Pharmacist: By redeeming this offer, the Pharmacist certifies that Teva’s ALYQ™ (tadalafil tablets, USP) is being dispensed to a patient eligible for this offer in compliance with these Terms and Conditions and the Pharmacy has not submitted and will not submit a claim for reimbursement under any federal, state, or other governmental program for this prescription. For Commercially-Insured Patients, please submit this claim to the primary Third-Party Payer first, then submit the balance due to CHANGE HEALTHCARE as a Secondary Payer COB (coordination of benefits) with patient responsibility and a valid Other Coverage Code (e.g. 8). For Insured/Not Covered Patients: If the patient has commercial insurance but you receive a “not covered” response because ALYQ™ is not on the patient’s formulary or is subject to prior authorization or step therapy and the patient has not met the criteria, continue the claim adjudication process and run the claim as secondary payer COB.  Submit the claim from the primary Third Party Payer to CHANGE HEALTHCARE as a Secondary Payer COB (coordination of benefits) with patient responsibility amount and process using Other Coverage Code (e.g. 3).  Reimbursement will be received from CHANGE HEALTHCARE.For questions about processing, please call 1-800-433-4893.

 

Information provided in this site is intended for US residents only. 

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© 2019 Teva Pharmaceuticals USA, Inc. TG-41842 January 2019
Adcirca® is a registered trademark of Eli Lilly and Company