`ARGENTUM
`IPR2018-00080
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`Through
`the
`UCERIS
`®
`Instant
`Savings
`Program,
`eligible
`patients
`with
`commercial
`insurance
`may pay no more than $25 copay for each UCERIS prescription (maximum
`benefits apply)*.
`
`Enroll Now in the UCERIS Instant Savings Program
`
`For eligible commercially–insured patients–download or activate a Uceris Instant Savings Card
`
`I do not have a savings card and would like to download and activate one now.
`
`I already have a savings card and would like to activate it now.
`
`*First name:
`
`eg, Jane
`
`*Last name:
`
`eg, Smith
`
`*Address 1:
`
`eg, 101 Lakeleaf Ct
`
`Address 2:
`
`eg, Suite 500
`
` (/tablet/)
`
`For Healthcare Professionals (/tablet/hcp/)Important Safety Information
`Prescribing Information (PDF) (http://shared.salix.com/shared/pi/ucerispi.pdf?id=792328)
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`000001
`
`
`
`*City:
`
`eg, San Francisco
`
`*State:
`
`*Zip:
`
`eg, 22222
`
`*Email:
`
`eg, janesmith@domain.com
`
`*Confirm Email:
`
`*Phone Number:
`
`*DOB:
`
`I certify that the patient who will use this savings card is an eligible commerciallyinsured patient.
`
`I certify that the patient who will use this savings card is not eligible for reimbursement of prescriptions (in whole
`or in part) under any federal, state or other governmental programs, including, but not limited to, Medicare
`(including Medicare Advantage and Part A, B and D plans), Medicaid, TRICARE, Veterans Administration or
`Department of Defense health coverage, CHAMPUS, the Puerto Rico Government Health Insurance Plan or any
`other federal or state healthcare programs.
`
`Yes! I am also interested in receiving additional communications (health tips, wellness tools, coupons, other
`discounts, educational materials, product information, etc) from Salix Pharmaceuticals or its affiliates
`
`*Captcha
`
`000002
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`
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`By clicking "Submit" and activating a Uceris Instant Savings Card, I confirm that I have read and
`understand the Eligibility Criteria, Terms and Conditions contained below, and that the patient who will
`use the savings card meets all eligibility criteria and will comply with all terms and conditions of the
`program.
`
`Submit
`
`Eligibility Criteria, Terms and Conditions
`This offer is only valid for patients 18 years of age or older with commercial insurance, including
`commercially insured patients without coverage for UCERIS. Patients without commercial insurance are
`not eligible.
`This offer is not valid for any person eligible for reimbursement of prescriptions, in whole or in part, by any
`federal, state, or other governmental programs, including, but not limited to, Medicare (including Medicare
`Advantage and Part A, B, and D plans), Medicaid, TRICARE, Veterans Administration or Department of
`Defense health coverage, CHAMPUS, the Puerto Rico Government Health Insurance Plan, or any other
`federal or state health care programs.
`Eligible insured patients with coverage for UCERIS must pay the first $25 of their copay and eligible
`insured patients without coverage for UCERIS must pay the first $25 of out of pocket expense and then
`Salix Pharmaceuticals will pay the remaining copay/out of pocket expense up to the maximum amount of
`$600 per fill.
`Maximum benefits apply. Maximum benefits are as follows: UCERIS tablets: $600/prescription, for up to
`one use per month for a calendar year; UCERIS rectal foam: $600/ prescription, for up to 8 uses in a
`calendar year. Offer expires December 31, 2016
`Patient is responsible for all additional costs and expenses after the maximum limit is reached
`You agree not to seek reimbursement for all or any part of the benefit received through this offer and are
`responsible for making any required reports of your use of this offer to any insurer, health plan, or other
`third party who pays any part of the prescription filled
`This savings program cannot be combined with any other coupon, certificate, voucher, or similar offer
`Offer good only in the USA at participating retail pharmacies and cannot be redeemed at government
`subsidized clinics
`Participation in this program must comply with all applicable laws and contractual or other obligations as a
`pharmacy provider
`This card has no cash value and no other purchase is necessary
`This is not health insurance
`Participating patients and pharmacists understand and agree to comply with the Terms and Conditions of
`this offer as set forth herein
`Any stepedits or prior authorizations required by the insurance plan still apply
`Salix Pharmaceuticals reserves the right to modify or cancel this program at any time
`The UCERIS Instant Savings Card
`Savings card must be activated prior to use by visiting www.uceris.com or by calling 855
`5581669
`Participating patients must present their activated UCERIS Instant Savings Card for every
`eligible prescription fill or refill
`
`Mail Order
`The UCERIS Instant Savings Card may be used for mailorder prescriptions
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`INDICATION
`
`UCERIS (budesonide) extended release tablets are a prescription corticosteroid medicine used to help get mild
`®
`to moderate active ulcerative colitis (UC) under control (induce remission). It is not known if UCERIS tablets are
`safe and effective in children.
`
`IMPORTANT SAFETY INFORMATION - UCERIS extended release tablets
`
`UCERIS extended release tablets are not for everyone. Do not take UCERIS tablets if you are allergic to
`budesonide or any of the ingredients in UCERIS tablets.
`UCERIS is a steroid. Longtime use of UCERIS tablets can cause you to have too much glucocorticosteroid
`medicine in your blood (hypercorticism). Tell your healthcare provider if you have any of the following signs
`and symptoms of hypercorticism: acne, bruise easily, rounding of your face (moon face), ankle swelling,
`thicker or more hair on your body and face, a fatty pad or hump between your shoulders (buffalo hump), or
`pink or purple stretch marks on the skin of your abdomen, thighs, breasts and arms.
`When UCERIS tablets are taken for a long period of time, the adrenal glands do not make enough steroid
`hormones. Tell your healthcare provider if you are under stress or have any of the following symptoms:
`tiredness, vomiting, weakness, low blood pressure, and nausea.
`
`Reimbursement:
`Benefits that could not be processed through mail order may qualify for reimbursement.
`Please visit www.patientrebateonline.com (https://www.patientrebateonline.com) for
`instructions on how to mail in your prescription receipt for reimbursement.
`
`*Restrictions apply. Please see "Eligibility Criteria, Terms and Conditions" above.
`
`Get tips on talking to your
`doctor about your UC.
`
`DOWNLOAD GUIDE
`(/PORTALS/106/ASSETS/PDF/UCERIS-
`DISCUSSION-GUIDE.PDF)
`
`Sign up to get updates
`about UCERIS.
`
`SIGN UP NOW
`(/TABLET/SIGN-UP/)
`
`Find answers to commonly
`asked questions about
`UCERIS and UC.
`
`GET ANSWERS
`(/TABLET/UCERIS-FAQ/)
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`
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`UCERIS tablets may weaken your immune system. Taking medicines that weaken your immune system
`makes you more likely to get infections. Avoid contact with people who have contagious diseases such as
`chickenpox or measles while taking UCERIS tablets.
`If you take certain other steroid medicines to treat allergies, switching to UCERIS tablets may cause your
`allergies to come back. These allergies may include eczema (a skin disease) or rhinitis (inflammation inside
`your nose). Tell your healthcare provider if any of your allergies become worse while taking UCERIS tablets.
`Before you take UCERIS tablets tell your healthcare provider if you have liver problems, are planning to
`have surgery, have an infection, have or had a family history of diabetes, cataracts or glaucoma, have or
`had tuberculosis, have high blood pressure (hypertension), have decreased bone mineral density
`(osteoporosis), stomach ulcers, or any other medical condition, are pregnant or plan to become pregnant,
`are breastfeeding or plan to breastfeed.
`Tell your healthcare provider about all the medicines you take, including prescription and overthecounter
`vitamins, and herbal supplements. UCERIS tablets and other medicines may affect each other and cause
`side effects.
`Do not eat grapefruit or drink grapefruit juice while taking UCERIS tablets. Eating grapefruit or drinking
`grapefruit juice can increase the level of this medicine in your blood.
`In clinical studies, the most common side effects (occurring in ≥ 2% of people) were headache, nausea,
`decreased blood cortisol (a hormone made by the adrenal glands), stomacharea pain, tiredness, stomach
`or intestinal gas, bloating, acne, urinary tract infection, joint pain, and constipation.
`
`You are encouraged to report negative side effects of prescription drugs to the FDA. Visit
`www.fda.gov/medwatch/ (http://www.fda.gov/medwatch/) or call 1800FDA1088.
`
`For product information, adverse event reports, and product complaint reports, please contact:
`
`Salix Product Information Call Center
`Phone: 18005080024
`Fax: 15105958183
`Email: salixmc@dlss.com (mailto:salix@medcomsol.com)
`
`Please click here for full Prescribing Information for UCERIS extended release tablets
`(http://shared.salix.com/shared/pi/ucerispi.pdf).
` (http://shared.salix.com/shared/pi/ucerispi.pdf)
`
`About UCERIS (/tablet/aboutuceris/)
`How UCERIS Works (/tablet/howucerisprovidesrelief/)
`Why UCERIS (/tablet/ucerisbenefits/)
`Taking UCERIS (/tablet/takinguceris/)
`Back To Top
`
`Understanding UC (/tablet/whatisulcerativecolitis/)
`Resources (/tablet/ulcerativecolitisresources/)
`Back To Top
`
`Back To Top
`
`The health information contained herein is provided for educational purposes only and is not intended to replace discussions with a
`healthcare provider. All decisions regarding patient care must be made with a healthcare provider, considering the unique characteristics of
`the patient.
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`
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`The product information provided in this site is intended only for residents of the United States. The products discussed herein may have
`different product labeling in different countries.
`
`(http://www.salix.com)
`
`Follow Salix on:
`
`(http://www.facebook.com/SalixPharma)
`
`(http://www.twitter.com/SalixPharma)
`Use of this site signifies your agreement to the Legal Notice (/tablet/termsofuse/). Privacy Policy (/tablet/privacypolicy/).
`Salix Pharmaceuticals
`8510 Colonnade Center Drive, Raleigh, NC 27615 USA
`T: 9089271700 (tel:919089271700),
`UCE.0029.USA.16
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