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`Register for Your Savings Card | Tradjenta® (linagliptin) Tablets
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`SEE IF YOU QUALIFY FOR THE TRADJENTA
`SAVINGS CARD
`
`GREAT!
`YOU ARE ELIGIBLE FOR THE TRADJENTA SAVINGS CARD. FILL IN THE INFORMATION BELOW.
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`*Required Fields
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`Please tell us about yourself:
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`I need a Savings Card
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`I have a Savings Card and need to activate it
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`My Savings Card has expired and I need to re-activate it
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`CONTACT INFORMATION
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`*First Name
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`*Last Name
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`*Email Address
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`*Confirm Email Address
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`https://www.tradjenta.com/savingscard/register
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`Register for Your Savings Card | Tradjenta® (linagliptin) Tablets
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`*Address Line 1
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`Address Line 2 (optional)
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`*City
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`*State
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`*Zip Code
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`*Date of Birth
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`MM
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`DD
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`YYYY
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`Phone Number (optional)
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`XXX - XXX - XXXX
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`*Please select the statement that best applies to you:
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`I am currently...
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`FOR U.S. RESIDENTS ONLY
`AGE 18 AND OVER
`What medications are you currently taking? (optional)
`
`Biguanide
`
`?
`
` (https://www.tradjenta.com)
`GLP-1 Agonist
`
`?
`
`DPP-4 Inhibitor
`
`?
`
`Sulfonylurea
`
`?
`
`Insulin
`?
` Important Safety Information
`En Español (http://www.espanol.tradjenta.com/)
`Other
`Prescribing Information & Medication Guide (http://bidocs.boehringer-ingelheim.com/BIWebAccess/ViewServlet.ser?
`
`Thiazolidinedione
`
`?
`
`docBase=renetnt&folderPath=/Prescribing+Information/PIs/Tradjenta/Tradjenta.pdf)
`Not taking any medications
`Other Medication Options (http://www.jentadueto.com) For Healthcare Professionals (http://hcp.tradjenta.com/)
`
`WHY
`Would you like to sign up for other offers and information?
`TRADJENTA? (HTTPS://WWW.TRADJENTA.COM/ABOUT)
`Yes. I allow Boehringer Ingelheim Pharmaceuticals, Inc. and
`ASK ABOUT
`Lilly USA, LLC and companies working with them to send me
`TRADJENTA (HTTPS://WWW.TRADJENTA.COM/ASK-ABOUT-TRADJENTA)
`health and product related information and offers regarding
`their products, like TRADJENTA.
`SIDE
`EFFECTS (HTTPS://WWW.TRADJENTA.COM/SIDE-EFFECTS)
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`Register for Your Savings Card | Tradjenta® (linagliptin) Tablets
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`TERMS AND CONDITIONS
`MANAGING
`TYPE 2 DIABETES (HTTPS://WWW.TRADJENTA.COM/MANAGE-TYPE-2-DIABETES)
`Eligible patients 18 years or older may pay as little as $10/month with a maximum savings up to $150/monthly
`SAVINGS CARD
`prescription. Card valid for 12 consecutive months from activation date. Eligible patients may re-enroll for
`ELIGIBILITY (HTTPS://WWW.TRADJENTA.COM/SAVINGS-CARD)
`additional 12 consecutive-month periods by reactivating expired card, benefits not to exceed program expiration
`on May 31, 2018. If you live in Massachusetts, card expires on the earlier of June 30, 2017, or date AB-rated
`TALK TO
`YOUR DOCTOR (HTTPS://WWW.TRADJENTA.COM/DOCTOR-DISCUSSION-GUIDE)
`generic equivalent is available. One card per patient, not transferable, and cannot be combined with any other
`offer. Program not health insurance. Only valid for commercially insured patients in the 50 United States, DC, and
`Puerto Rico. Not eligible if prescriptions are paid for in part/full by state or federally funded program(s), like
`Medicare Part D, Medicaid, Vet. Aff., Dept. of Def., or TRICARE and where prohibited by law. Offer may change at
`any time, without notice.
`
`REGISTER NOW
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`Boehringer Ingelheim Pharmaceuticals, Inc. and Lilly USA, LLC respect your privacy.
`By downloading or activating a savings card, you allow Boehringer Ingelheim Pharmaceuticals, Inc. and Lilly USA,
`LLC and companies working with us, to use your registration information to: (1) administer your benefits; (2)
`contact you about the Savings Card; and (3) evaluate the Savings Card program in relation to your card usage
`received from the pharmacy.
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`IMPORTANT SAFETY INFORMATION AND INDICATION
`
`WHAT IS THE MOST IMPORTANT INFORMATION I SHOULD KNOW ABOUT TRADJENTA?
`FOR U.S. RESIDENTS ONLY
`Serious side effects can happen to people taking TRADJENTA, including inflammation of the pancreas
`AGE 18 AND OVER
`(pancreatitis), which may be severe and lead to death. Before you start taking TRADJENTA, tell your doctor if you
` (https://www.tradjenta.com)
`have ever had pancreatitis, gallstones, a history of alcoholism, or high triglyceride levels.
`
`Stop taking TRADJENTA and call your doctor right away if you have pain in your stomach area (abdomen) that is
`En Español (http://www.espanol.tradjenta.com/)
` Important Safety Information
`severe and will not go away. The pain may be felt going from your abdomen through to your back. The pain may
`happen with or without vomiting. These may be symptoms of pancreatitis.
`Prescribing Information & Medication Guide (http://bidocs.boehringer-ingelheim.com/BIWebAccess/ViewServlet.ser?
`docBase=renetnt&folderPath=/Prescribing+Information/PIs/Tradjenta/Tradjenta.pdf)
`WHO SHOULD NOT TAKE TRADJENTA?
`Other Medication Options (http://www.jentadueto.com) For Healthcare Professionals (http://hcp.tradjenta.com/)
`Do not take TRADJENTA if you are allergic to linagliptin or any of the ingredients in TRADJENTA.
`
`WHY
`Symptoms of a serious allergic reaction to TRADJENTA may include rash, itching, flaking or peeling; raised red
`TRADJENTA? (HTTPS://WWW.TRADJENTA.COM/ABOUT)
`patches on your skin (hives); swelling of your face, lips, tongue and throat that may cause difficulty breathing or
`swallowing. If you have any symptoms of a serious allergic reaction, stop taking TRADJENTA and call your doctor
`ASK ABOUT
`or go to the emergency room right away.
`TRADJENTA (HTTPS://WWW.TRADJENTA.COM/ASK-ABOUT-TRADJENTA)
`
`WHAT SHOULD I TELL MY DOCTOR BEFORE USING TRADJENTA?
`SIDE
`EFFECTS (HTTPS://WWW.TRADJENTA.COM/SIDE-EFFECTS)
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`Register for Your Savings Card | Tradjenta® (linagliptin) Tablets
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`Tell your doctor about all your medical conditions, including if you have or have had inflammation of your pancreas
`MANAGING
`(pancreatitis).
`TYPE 2 DIABETES (HTTPS://WWW.TRADJENTA.COM/MANAGE-TYPE-2-DIABETES)
`
`Tell your doctor about all the medicines you take, including prescription and over‑the‑counter medicines, vitamins,
`SAVINGS CARD
`and herbal supplements. TRADJENTA may affect the way other medicines work, and other medicines may affect
`ELIGIBILITY (HTTPS://WWW.TRADJENTA.COM/SAVINGS-CARD)
`how TRADJENTA works. Especially tell your doctor if you take
`TALK TO
`YOUR DOCTOR (HTTPS://WWW.TRADJENTA.COM/DOCTOR-DISCUSSION-GUIDE)
`other medicines that can lower your blood sugar. If you take TRADJENTA with another medicine that can
`cause low blood sugar, such as sulfonylurea or insulin, your risk of getting low blood sugar is higher. The
`dose of your sulfonylurea or insulin may need to be lowered while you take TRADJENTA.
`rifampin (Rifadin , Rimactane , Rifater , Rifamate )*, an antibiotic that is used to treat tuberculosis.
`®
`®
`®
`®
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`*These trademarks are owned by third parties not affiliated with TRADJENTA.
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`Tell your doctor if you are pregnant or planning to become pregnant or are breastfeeding or plan to breastfeed.
`
`WHAT ARE THE POSSIBLE SIDE EFFECTS OF TRADJENTA?
`TRADJENTA may cause serious side effects, including
`
`Inflammation of the pancreas (pancreatitis).
`Low blood sugar (hypoglycemia), especially if you take TRADJENTA with another medicine that can cause
`low blood sugar. Signs and symptoms of low blood sugar may include headache, drowsiness, weakness,
`dizziness, confusion, irritability, hunger, fast heartbeat, sweating, or feeling jittery.
`Allergic (hypersensitivity) reactions can happen after your first dose or up to 3 months after starting
`TRADJENTA. Symptoms may include swelling of your face, lips, throat, and other areas on your skin;
`difficulty with swallowing or breathing; raised, red areas on your skin (hives); skin rash, itching, flaking, or
`peeling.
`Joint pain. Some people who take medicines called DPP-4 inhibitors like TRADJENTA, may develop joint pain
`that can be severe. Call your doctor if you have severe joint pain.
`
`The most common side effects of TRADJENTA include stuffy or runny nose, sore throat, cough and diarrhea.
`
`These are not all the possible side effects of TRADJENTA. For more information, ask your doctor or pharmacist.
`You are encouraged to report negative side effects of prescription drugs to the FDA. Visit
`FOR U.S. RESIDENTS ONLY
`www.fda.gov/medwatch (http://www.fda.gov/medwatch) or call 1‑800‑FDA‑1088.
`AGE 18 AND OVER
`
`WHAT IS TRADJENTA?
` (https://www.tradjenta.com)
`TRADJENTA is a prescription medicine that is used along with diet and exercise to lower blood sugar in adults
`with type 2 diabetes.
`
`En Español (http://www.espanol.tradjenta.com/)
` Important Safety Information
`TRADJENTA is not for people with type 1 diabetes or for people with diabetic ketoacidosis (increased ketones in
`Prescribing Information & Medication Guide (http://bidocs.boehringer-ingelheim.com/BIWebAccess/ViewServlet.ser?
`the blood or urine).
`
`docBase=renetnt&folderPath=/Prescribing+Information/PIs/Tradjenta/Tradjenta.pdf)
`Other Medication Options (http://www.jentadueto.com) For Healthcare Professionals (http://hcp.tradjenta.com/)
`If you have had inflammation of the pancreas (pancreatitis) in the past, it is not known if you have a higher chance
`of getting pancreatitis while you take TRADJENTA.
`WHY
`TRADJENTA? (HTTPS://WWW.TRADJENTA.COM/ABOUT)
`
`TJ CONS lSI 31AUG2015
`
`For more safety information, please see Medication Guide and full Prescribing Information
`ASK ABOUT
`TRADJENTA (HTTPS://WWW.TRADJENTA.COM/ASK-ABOUT-TRADJENTA)
`(http://bidocs.boehringer-ingelheim.com/BIWebAccess/ViewServlet.ser?
`docBase=renetnt&folderPath=/Prescribing+Information/PIs/Tradjenta/Tradjenta.pdf).
`SIDE
`EFFECTS (HTTPS://WWW.TRADJENTA.COM/SIDE-EFFECTS)
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`https://www.tradjenta.com/savingscard/register
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`Register for Your Savings Card | Tradjenta® (linagliptin) Tablets
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`MANAGING
`TYPE 2 DIABETES (HTTPS://WWW.TRADJENTA.COM/MANAGE-TYPE-2-DIABETES)
`
` (http://us.boehringer-ingelheim.com/)
`SAVINGS CARD
`ELIGIBILITY (HTTPS://WWW.TRADJENTA.COM/SAVINGS-CARD)
`
`TALK TO
`YOUR DOCTOR (HTTPS://WWW.TRADJENTA.COM/DOCTOR-DISCUSSION-GUIDE)
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`FOR U.S. RESIDENTS ONLY
`AGE 18 AND OVER
`
` (https://www.tradjenta.com)
`
` Important Safety Information
`En Español (http://www.espanol.tradjenta.com/)
`Prescribing Information & Medication Guide (http://bidocs.boehringer-ingelheim.com/BIWebAccess/ViewServlet.ser?
`
`docBase=renetnt&folderPath=/Prescribing+Information/PIs/Tradjenta/Tradjenta.pdf)
`Other Medication Options (http://www.jentadueto.com) For Healthcare Professionals (http://hcp.tradjenta.com/)
`
`WHY
`TRADJENTA? (HTTPS://WWW.TRADJENTA.COM/ABOUT)
`
`ASK ABOUT
`TRADJENTA (HTTPS://WWW.TRADJENTA.COM/ASK-ABOUT-TRADJENTA)
`
`SIDE
`EFFECTS (HTTPS://WWW.TRADJENTA.COM/SIDE-EFFECTS)
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