Thank you for your interest in a coupon for up to $20 off of LOVAZA. Present the coupon and your prescription to your pharmacist when you request your LOVAZA.
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TO THE PATIENT: This coupon can be used whether or not you have insurance for the amount of your out-of-pocket expense for this prescription up to a maximum of $20 per use. This coupon must be accompanied by a valid, signed prescription for LOVAZA. You are NOT eligible to use this coupon if this prescription is covered by or will be submitted for reimbursement under any federal healthcare program, including Medicaid, Medicare (Part D or otherwise), or any similar federal or state programs, including any state pharmaceutical assistance program. Further, you MUST NOT be Medicare eligible and enrolled in an employer-sponsored health plan or employer-sponsored prescription drug benefit plan for retirees (ie, you are eligible for Medicare Part D but receive a prescription drug benefit through a former employer).
Not valid for residents of Massachusetts unless paying full cost of prescription (ie, insurance does not cover any of the costs of this prescription). Your acceptance of this offer must be consistent with terms of any drug benefit plan provided to you by your health insurer. You agree to report your use of this coupon to your health insurer if required. Only original accepted; not valid if reproduced. One use per purchase. May not be used with any other discount or other offers. Offer good only in USA and Puerto Rico. Void where prohibited by law, taxed, or restricted. GlaxoSmithKline and McKesson (on behalf of GlaxoSmithKline) reserve the right to rescind, revoke, or amend this coupon without notice.
By redeeming this coupon, I, the Patient, certify that: (i) I have read the program rules and regulations, terms and conditions; (ii) I have not submitted and will not submit a claim for reimbursement under any federal, state, or other governmental programs for this prescription; (iii) if I am Medicare eligible, I am not enrolled in an employer-sponsored health plan for retirees or a Medicare Part D Plan; and (iv) I will otherwise comply with the terms above.
This coupon is the property of GlaxoSmithKline and must be returned upon request.