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Just print your savings card and follow these 3 simple steps.

  1. GET A NEXIUM PRESCRIPTION from your doctor
  2. CONFIRM YOUR ELIGIBILITY
  3. BRING SAVINGS CARD and prescription to your pharmacy

 

EC57005168
414610714658

EC57005164
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NEXIUM Savings Card

*Individual out-of-pocket costs may vary. Program eligibility restrictions apply.

 

*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 or for patients younger than one month of age. This offer is valid for retail prescriptions only.

TERMS OF USE: Eligible commercially insured patients with a valid prescription for NEXIUM® (esomeprazole magnesium) who present this savings card at participating pharmacies will pay $15 for a 30-day supply or $30 for a 60-day supply or 90-day supply, subject to a maximum savings of $175 per 30-day supply. Cash-paying patients will receive up to $125 in savings on out-of-pocket costs per 30-day supply. This offer is good for 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 1-877-703-72831-877-703-7283.

This offer will expire on 12/31/2019.

Non-transferable, 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 NEXIUM 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.

Pharmacist Instructions for a Patient With an Eligible Third Party Payer: Submit the claim to the primary Third-Party Payer first, then submit the balance due to Therapy First Plus as a Secondary Payer COB (coordination of benefits) with patient responsibility amount and a valid Other Coverage Code (eg, 8). The patient is responsible for the first $15 on 30-day supply, $30 on 60-day supply, or $30 on 90-day supply, and the card will cover up to $175 per 30-day supply. Reimbursement will be received from Therapy First Plus.

Pharmacist Instructions for a Cash-Paying Patient: Submit this claim to Therapy First Plus. A valid Other Coverage Code (eg,1) is required. The patient is responsible for the first $15 on 30-day supply, $30 on 60-day supply, or $30 on 90-day supply and the card will cover up to $125 per 30-day supply. Reimbursement will be received from Therapy First Plus.

Valid Other Coverage Code Required: For any questions regarding Therapy First Plus online processing, please call the Help Desk at 1-800-422-56041-800-422-5604. Program managed by PSKW on behalf of AstraZeneca.

If you can't afford your medication, AstraZeneca may be able to help. For more information, please visit AstraZeneca-us.com. NEXIUM and the color purple as applied to the capsule are registered trademarks of the AstraZeneca group of companies. Product dispensed pursuant to program rules and federal and state laws.

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