Details and eligibility information

Eligibility Criteria: This offer is valid for eligible patients purchasing ZYPITAMAG® and may not be used for any other product. This offer is valid for the purchase of ZYPITAMAG manufactured for Medicure and lawfully purchased from an authorized retailer or distributor in the United States or its territories. This offer is valid for patients being treated with ZYPITAMAG for an FDA-approved indication who are 18 years of age or older. Patients who are enrolled in Medicare, Medicaid, or another state or federal healthcare program may only use this Savings Offer if paying for the prescription covered by this Savings Offer outside of their government insurance benefit, and no claim is submitted to Medicare, Medicaid, or any federal or state healthcare program. Such patients must not apply any out-of-pocket expenses incurred using this Savings Offer toward any government insurance benefit out-of-pocket spending calculations, such as Medicare Part D true out-of-pocket (TrOOP) costs. Patients who decline their government coverage to pay cash and use this offer must not submit a claim for ZYPITAMAG® to any government prescription drug benefits program even if their coverage has changed since their initial use of this offer. All Program payments are for the benefit of the patient only. The patient is responsible for applicable taxes, if any. The Dual Savings Card may not be sold, purchased, traded, or counterfeited. This offer is not conditioned on any past, present, or future purchase, including refills. Offer not valid where prohibited by law or restricted. This offer is non-transferable, is limited to one per person, and may not be combined with any other offer. Offer must be presented along with a valid prescription for ZYPITAMAG at the time of purchase. Medicure reserves the right to change or discontinue this offer at any time without notice.

To the Patient: Take your ZYPITAMAG® (pitavastatin) tablets Dual Savings Card along with your prescription to your pharmacist. This card covers out of pocket costs that exceed $10 per month (up to a maximum of $85 off per month) on each 30-day supply. For cash paying patients, this card covers up to $183 off for a 30-day supply. By using this offer, you are certifying that you meet the eligibility criteria and will comply with the terms and conditions described herein and will not seek reimbursement for any benefit received through this card. You are responsible for reporting use of the Dual Savings Card to any private insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the Dual Savings Card.

To the Pharmacist: By using this offer, you are certifying that the patient meets the eligibility criteria and will comply with the terms and conditions described herein.

1. For Eligible Insured Patients: Process a Coordination of Benefits (COB/split bill) claim using the patient's prescription insurance for the PRIMARY
   claim. Submit a SECONDARY claim under BIN: 015202.
2. For Eligible Cash Paying Patient: Submit a PRIMARY claim under BIN: 015202. For pharmacy processing questions, please call 313.821.3200 ext. 202 or email network@sgrxhealth.com.

For pharmacy processing questions, please call 866-420-7732 (Monday - Friday 24 hours, Saturday 8 AM - 7 PM EST, and Sunday 9 AM - 5 PM EST)