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What’s your prescription co-pay for BRILINTA?

With the $18* Card, commercially insured patients may save on refills

  • Commercially insured patients: Eligible patients will pay $18 for a 30-day supply, a 60-day supply or a 90-day supply, subject to a maximum savings of $100 per 30-day supply.

*Subject to eligibility rules below; restrictions apply.

Eligibility for Savings Card

Eligibility: You may be eligible for this offer if you are insured by commercial insurance and your insurance does not cover the full cost of your prescription, or you are not insured and are responsible for the cost of your prescriptions.

Patients who are enrolled in a state or federally funded prescription insurance program are not eligible for this offer. This includes patients enrolled in Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DOD) programs or TriCare, and patients who are Medicare eligible and enrolled in an employer-sponsored group waiver health plan or government-subsidized prescription drug benefit program for retirees.

If you are enrolled in a state or federally funded prescription insurance program, you may not use this Savings Card even if you elect to be processed as an uninsured (cash-paying) patient.

This offer is not insurance and is restricted to residents of the United States and Puerto Rico and patients 18 years of age or older. This offer is valid for retail prescriptions only.

Terms of Use: Eligible commercially insured patients with a valid prescription for BRILINTA® (ticagrelor) tablets who present this offer at participating pharmacies will pay $18 for a 30-day supply, a 60-day supply, or a 90-day supply, subject to a maximum savings of $100 per 30-day supply. Cash-paying patients will receive up to $100 in savings on out-of-pocket costs per 30-day supply. Per calendar year, your card is subject to a $1200 annual program benefit, or 12 uses (and each 30-day supply counts as 1 use), whichever comes first. Patients who remain eligible are automatically reenrolled. This offer is good for a 30-day supply, 60-day supply, or 90-day supply. Other restrictions may apply. Patient is responsible for applicable taxes, if any. If you have any questions regarding this offer, please call 1-888-512-7454.

Nontransferable, limited to one per person, cannot be combined with any other offer. Void where prohibited by law, taxed, or restricted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer. AstraZeneca reserves the right to rescind, revoke, or amend this offer, eligibility, and terms of use at any time without notice. This offer is not conditioned on any past, present, or future purchase, including refills. Offer must be presented along with a valid prescription for BRILINTA at the time of purchase.

BY USING THIS CARD, YOU AND YOUR PHARMACIST UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

Program managed by PSKW, LLC, on behalf of AstraZeneca.

Eligibility for Mail-Order Rebate

Eligibility: You may be eligible for this offer if you are insured by commercial insurance and your insurance does not cover the full cost of your prescription, or you are not insured and are responsible for the cost of your prescriptions. Patients who are enrolled in a state or federally funded prescription insurance program are not eligible for this offer. This includes patients enrolled in Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DOD) programs or TriCare, and patients who are Medicare eligible and enrolled in an employer-sponsored group waiver health plan or government-subsidized prescription drug benefit program for retirees. If you are enrolled in a state or federally funded prescription insurance program, you may not use this rebate form even if you elect to be processed as an uninsured (cash-paying) patient. This offer is not insurance and is restricted to residents of the United States and Puerto Rico and patients 18 years of age or older.

Terms of Use: This offer is good for eligible patients purchasing a 90-day supply (up to 180 tablets) of BRILINTA® (ticagrelor) tablets through a mail-order pharmacy and may not be used for any other product. If you have commercial insurance for your prescriptions and your copay is more than $18 for a 90-day supply, you will pay the first $18 and receive up to $300 in savings from AstraZeneca. If you pay cash for your prescriptions, you will receive up to $300 in savings from AstraZeneca for a 90-day supply. This offer is good for a 90-day supply. Per calendar year, this mail order benefit is subject to a $1200 annual program benefit, or 4 uses, whichever comes first. Patients who remain eligible are automatically reenrolled. If you have any questions regarding this offer, please call 1-888-512-7454.

Nontransferable, limited to one per person, cannot be combined with any other offer. Void where prohibited by law, taxed, or restricted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer. AstraZeneca reserves the right to rescind, revoke, or amend this offer, eligibility, and terms of use at any time without notice. This offer is not conditioned on any past, present, or future purchase, including refills. Offer must be presented along with a valid prescription for BRILINTA at the time of purchase.

BY USING THIS REBATE FORM, YOU AND YOUR PHARMACIST UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

Program managed by PSKW, LLC, on behalf of AstraZeneca.