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Welcome to the Antara
Refill Reminder Program!
This page is intended for use by patients and pharmacists currently participating in the Antara Pay No More Than $25 Instant Savings Card.
ANTARA ® 130mg (fenofibrate) capsules & 43mg
PHARMACY PROCESSING INSTRUCTIONS:
Use the BIN, Group and Member Number on the patient’s phone to process this claim.
For Insured Patients:
Process a Coordination of Benefits (COB/split bill) claim using your patient’s prescription insurance for the PRIMARY claim. Submit a SECONDARY claim to PDM under BIN# 610020. After the first $25 of an Rx is paid, this card will pay up to $100 off the patient's remaining out-of-pocket expense for a 130mg Rx or up to $35 for a 43mg Rx.For Uninsured Patients:
Submit claim to PDM under BIN# 610020.
Your pharmacy will be paid a processing fee for successful adjudication of this claim.
For processing questions, please call 1-877-297-3302.
ELIGIBILITY CRITERIA:
| * | This coupon is not valid for prescriptions purchased under
Medicaid, Medicare, Medicare Part D or a Medicare-endorsed drug
discount card, federal or state programs (including any state
prescription drug programs), or private indemnity or HMO insurance
plans that reimburse you for the entire cost of your prescription
drugs. |
| * | You must deduct the value of this coupon from any reimbursement request submitted to an insurance plan, either directly by you or on your behalf. |
| * | Offer void in Massachusetts except for patients with no prescription drug
coverage. |
| * | Coupon cannot be combined with any other rebate/coupon, free trial, or similar offer. |
| * | After the first
$25 of an Rx is paid, this coupon/rebate is good for up to $100 off the remaining out-of-pocket expense for a 130mg
Rx or up to $35 for a 43mg Rx. |
| * | One coupon/rebate per prescription, not to exceed 12
prescriptions total for this offer period. You can re-enroll if
card is lost. Coupon/rebate is not transferable. |
| * | Lupin reserves the right to rescind,
revoke, or amend this offer without notice. You understand and agree to comply with the terms and conditions of
this offer as set forth above. |
| * | Only valid in the U.S. |
| * | It is a violation of federal law to buy, sell or counterfeit
this savings card. |
| * | Message and Data rates may apply. |
