Manufactured for: Horizon Pharma USA, Inc. Deerfield, IL 60015
`
`NDC 75987-031-04
`
`Usual Dosage: Take one
`tablet twice daily at least 30
`minutes before meals. Tablets
`are to be swallowed whole
`with liquid. Do not split, chew,
`crush or dissolve the tablet.
`Storage: Store at 25⁰C (77⁰F);
`excursions permitted to
` 15-30⁰C (59-86⁰F) [see USP
`
`Controlled Room Temperature].
`Store in the original container
`and keep the bottle tightly
`closed to protect from moisture.
`Dispense in a tight container
`if package is subdivided.
`Keep out of the reach of children.
`
`Reference ID: 3721190
`
`

`

`Manufactured for: Horizon Pharma USA, Inc. Deerfield, IL 60015
`
`NDC 75987-030-04
`
`Usual Dosage: Take one
`tablet twice daily at least 30
`minutes before meals. Tablets
`are to be swallowed whole
`with liquid. Do not split, chew,
`crush or dissolve the tablet.
`Storage: Store at 25⁰C (77⁰F);
`excursions permitted to
` 15-30⁰C (59-86⁰F) [see USP
`
`Controlled Room Temperature].
`Store in the original container
`and keep the bottle tightly
`closed to protect from moisture.
`Dispense in a tight container
`if package is subdivided.
`Keep out of the reach of children.
`
`Reference ID: 3721190
`
`

`

`NDC 75987-030-73
`
`(59-86⁰F) [see USP Controlled Room Temperature].
`
`Usual Dosage: Take one tablet twice daily at
`
`least 30 minutes before meals. Tablets are to be
`
`swallowed whole with liquid. Do not split, chew,
`crush or dissolve the tablet. Storage: Store at
`
`25⁰C (77⁰F); excursions permitted to 15-30⁰C
`
`Store in the original container and keep the bottle
`tightly closed to protect from moisture. Dispense
`in a tight container if package is subdivided.
`Keep out of the reach of children.
`*Each tablet contains 22.3 mg esomeprazole
`
`magnesium, equivalent to 20 mg of esomeprazole.
`
`Mfd. For: Horizon Pharma USA, Inc.
`Deerfield, IL 60015
`
`Reference ID: 3721190
`
`

`

`NDC 75987-030-73
`
`NDC 75987-030-73
`
`Usual Dosage: Take one tablet
`twice daily at least 30 minutes before
`meals. Tablets are to be swallowed
`whole with liquid. Do not split, chew,
`crush or dissolve the tablet.
`Storage: Store at 25⁰C (77⁰F);
`excursions permitted to 15-30⁰C
`(59-86⁰F) [see USP Controlled Room
`Temperature]. Store in the original
`container and keep the bottle tightly
`closed to protect from moisture.
`Dispense in a tight container if
`package is subdivided.
`Keep out of the reach of children.
`
`Mfd. For: Horizon Pharma USA, Inc.
`Deerfield, IL 60015
`
`004682
`CN
`EC72003002
`48658723291
`
`Redeem this card only when accompanied by valid
`prescription for VIMOVO. Card valid toward out-of-pocket
`expenses for VIMOVO. Minimum prescription 20 pills. A
`savings of up to $800 will be received for each prescription
`of 60 pills for a 30-day supply. Savings for prescriptions of
`+/- 60 pills may vary based on prescription size. Payment
`will be made by Therapy First Plus. Pharmacist for
`patient with eligible third party—Submit this claim to
`primary third-party payer first, then submit balance due
`to Therapy First Plus as Secondary Payer COB
`(coordination of benefits) with patient responsibility amount
`and valid Other Coverage Code (eg, 8). Pharmacist for
`cash-paying patient—Submit this claim to Therapy First
`Plus. Valid Other Coverage Code (eg, 1) is required. For any
`questions regarding Therapy First Plus online processing,
`please call 1-800-422-5604. Patients with questions
`should call 1-855-881-3093. Terms and Conditions:
`Card cannot be combined with any other rebate or coupon,
`free trial or similar offer for the specified prescription. Not
`valid for prescriptions reimbursed in whole or in part by
`Medicaid, Medicare, or other federal or state programs
`(including state prescription drug programs). Patients must
`be 18 or older. Offer good only in the United States at
`participating
`retail pharmacies. Offer not
`valid
`in Massachusetts or where otherwise prohibited by law.
`Horizon Pharma reserves the right to rescind, revoke
`or amend offer without notice. The selling, purchasing,
`trading or counterfeiting of this card is prohibited by law.
`Participating patients and pharmacists understand and
`agree to comply with all Terms and Conditions of offer.
`Program managed by PSKW & Associates on behalf of
`Horizon Pharma.
`Please see accompanying full Prescribing Information,
`including Boxed WARNINGS, with Medication Guide or
`visit www.VIMOVO.com.
`
`Reference ID: 3721190
`
`