*Offer restrictions and eligibility requirements: Offer is not valid for prescriptions being fully or partially reimbursed under Medicaid, a Medicare drug benefit plan, or other federal or state programs (such as medical assistance programs). The patient is responsible for reporting receipt of this offer to any health insurer, health plan, or third-party payer as may be required. By using this card, you agree that you will not submit a claim for the prescription to a government payer. If any part of your prescription is paid for by a nongovernmental third-party payer, you attest to having disclosed this offer to your third-party payer. The use of this card is subject to applicable state and federal law.