Printable Divigel® (estradiol gel) coupon.
BIN:
004682
PCN:
CN
Group:
WCDIV8132
ID:
81312832123
Printable Divigel® (estradiol gel) coupon.

Save up to
$25
per month*

BIN:

004682

PCN:

CN

Group:

WCDIV8132

ID:

81312832123

Simply present this offer when dropping off your prescription.

No activation required!

Start saving on the #1 prescribed
transdermal estrogen gel.1*

*For eligible patients only. Limited to a maximum savings of up to $25 on each 30-day supply of Divigel®.

IMPORTANT SAFETY INFORMATION & INDICATION
Divigel® (estradiol gel) 0.1% is indicated for the treatment of moderate to severe hot flashes due to menopause.

What is the most important information I should know about Divigel® (an estrogen hormone)?
  • Using estrogen-alone increases your chance of getting cancer of the uterus (womb). Report any unusual vaginal bleeding right away while you are using Divigel®. Vaginal bleeding after menopause may be a warning sign of cancer of the uterus (womb). Your healthcare provider should check any unusual bleeding to find out the cause.
  • Do not use estrogen-alone to prevent heart disease, heart attacks, strokes or dementia (decline of brain function)
  • Using estrogen-alone may increase your chances of getting strokes or blood clots
  • Using estrogen-alone may increase your chance of getting dementia, based on a study of women 65 years of age or older
  • Do not use estrogens with progestins to prevent heart disease, heart attacks, strokes or dementia
  • Using estrogens with progestins may increase your chances of getting heart attacks, strokes, breast cancer, or blood clots
  • Using estrogens with progestins may increase your chance of getting dementia, based on a study of women 65 years of age or older
  • You and your healthcare provider should talk regularly about whether you still need treatment with Divigel®

Divigel® should not be used if you have unusual vaginal bleeding, currently have or have had certain cancers, including cancer of the breast or uterus, had a stroke or heart attack; currently have or have had blood clots, currently have or have had liver problems, have been diagnosed with a bleeding disorder, or if you are allergic to Divigel® or any of its ingredients.

Tell your healthcare provider about all of your medical problems and the medicines you take, if you are going to have surgery or will be on bed rest, and if you are breastfeeding.

Call your healthcare provider right away if you get any of the following symptoms: new breast lumps, unusual vaginal bleeding, changes in vision or speech, sudden new severe headaches, or severe pains in your chest or legs with or without shortness of breath, weakness and fatigue.

Common side effects that may occur with Divigel® include irregular vaginal bleeding or spotting; breast tenderness, vaginal yeast infection, cold, and upper respiratory tract infection.

Serious but less common side effects include heart attack, stroke, blood clots, dementia, breast cancer, cancer of the uterus, low blood calcium (hypocalcemia), fluid retention, ovarian cancer, high blood pressure, high blood sugar, low thyroid

levels in your blood, gallbladder disease, liver problems, enlargement of benign uterus tumors (“fibroids”), high triglyceride (fat) levels in your blood, high blood calcium (hypercalcemia), worsening of angioedema (swelling of face and tongue) and changes in certain laboratory test results. Alcohol-based gels are flammable. Avoid fire, flame or smoking until the gel has dried.

You may report side effects to Vertical Pharmaceuticals, LLC at 1-877-95-VERTI (1-877-958-3784), or to the FDA at 1-800-FDA-1088.

For more information, please see Patient Information for Divigel® and talk to your healthcare provider. You may also call customer service at 866-600-4799 or visit www.divigel.com. This card is valid for up to 12 uses for Divigel® (estradiol gel) 0.1%.

For a patient with an Eligible Third Party: 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 (e.g. 8). The patient pay amount for a 30-day supply will be reduced up to $25 (after the patient pays the first $25). The patient pay amount for a 60-day supply will be reduced up to $50 (after the patient pays the first $50). For a 90-day supply, the patient pay amount will be reduced up to $75 (after the patient pays the first $75). Reimbursement will be received from Therapy First Plus. Valid Other Coverage Code required.

For Cash Paying Patients: Submit this claim to Therapy First Plus. A valid Other Coverage Code (e.g. 1) is required. The patient pay amount for a 30-day supply will be reduced up to $25 (after the patient pays the first $25). The patient pay amount for a 60-day supply will be reduced up to $50 (after the patient pays the first $50). For a 90-day supply, the patient pay amount will be reduced up to $75 (after the patient pays the first $75). 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 1-800-433-4893. Patients with questions should call 1-844-727-5540. You may report side effects to Vertical Pharmaceuticals, LLC at 1-877-482-3788, or to the FDA at 1-800-FDA-1088.

Program Rules – Eligibility, Terms, & Conditions: This offer is valid in the United States. Offer not valid for prescriptions reimbursed under Medicaid, a Medicare drug benefit plan, TRICARE, or other federal or state health programs (such as medical assistance programs). Cash Discount Cards and other non-insurance plans are not valid as primary under this offer. If the patient is eligible for drug benefits under any such program, the patient cannot use this offer. By using this offer, the patient certifies that he or she will comply with any terms of his or her health insurance contract requiring notification to his or her payor of the existence and/or value of this offer. It is illegal to (or offer to) sell, purchase, or trade this offer. This offer is not transferable and is limited to one offer per person. Not valid if reproduced. Void where prohibited by law. Vertical Pharmaceuticals, LLC reserves the right to rescind, revoke, or amend this offer without notice at any time.