Glenmark Dermatology Savings Program Eligibility
Participation is subject to certain limitations and restrictions. Please review the full Terms, Conditions, and Eligibility Criteria below.
Eligibility Certification
Question 1: Do you have commercial/private prescription drug insurance?
Question 2: Are you enrolled in a federal or state prescription drug insurance program?
Question 3: Are you a resident of the United States or Puerto Rico?

By activating your card, you certify that you are not enrolled in a federal or state funded prescription drug benefit program, such as Medicare, Medicaid, or any private indemnity or HMO insurance plan that reimburses you for the entire cost of your prescription drugs. You also certify that you are not Medicare-eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees. You further certify that should you begin receiving prescription benefits from one of these types of programs at any time, you will no longer participate in this savings program.

I accept the Program Terms, Conditions, and Eligibility Criteria available below.

Program Terms, Conditions, and Eligibility Criteria:
1. This offer is valid only for eligible patients, 18 years and older, and is good for use only with a valid prescription for Ecoza® (econazole nitrate) topical foam 1%, Neosalus® Cream (100 g) or Foam (200 g), or Recedo® Topical Gel at the time the prescription is filled by the pharmacist and dispensed to the patient. 2. Depending on your insurance coverage, eligible patients may pay as little as $25 and the card pays up to the maximum benefit for each product. Check with your pharmacist for your copay discount. Maximum savings limit applies; patient out-of-pocket expense may vary. 3. This offer is valid only for patients with commercial/private insurance and is not valid for prescriptions that are eligible to be reimbursed in whole or part by Medicare, Medicaid, or a Medicare Part D Plan, Tricare, VA, DoD, Puerto Rico Government Health Insurance Plan, or other federal or state programs (including any state pharmaceutical assistance programs), or private indemnity or HMO Insurance plans that reimburse you for the entire cost of your prescription drugs. Patients may not use this offer if they are Medicare eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees. Patients without insurance coverage are considered “cash-pay” patients. Medicare Part D enrollees who are in the prescription drug coverage gap (the “donut hole”) are not eligible for the co-pay coupon. Patients who begin receiving prescription benefits from such Government Programs at any time will no longer be eligible to use the card. 4. Glenmark Therapeutics reserves the right to rescind, revoke, or amend this offer without notice. 5. Offer good only for use by eligible residents of the USA, including Puerto Rico, at participating retail, specialty, or mail-order pharmacies. 6. Void if prohibited by law, taxed, or restricted. 7. This card is not transferable. No substitutions are permitted. The selling, purchasing, trading, or counterfeiting of this card is prohibited by law. 8. This card has no cash value and may not be used in combination with any other discount coupon, discount card, rebate, free trial, or similar offer for the specified prescription. Patient may not be currently receiving drug assistance through any Glenmark Therapeutics patient assistance programs. 9. This offer is not health insurance and is not intended to substitute for insurance. Patient, pharmacist and prescriber agree not to seek reimbursement for all or any part of the benefit received by the patient through the offer. 10. Both patient and pharmacist are each individually responsible for reporting receipt of coupon benefit to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the card, as required. 11. By redeeming this card, you acknowledge that you are an eligible patient and that you understand and agree to comply with the terms and conditions of this offer.The card may not be redeemed more than once per 30 days per patient. Certain information pertaining to your use of the card may be shared with Glenmark Therapeutics, the sponsor of the card, and/or its vendors. The information disclosed will include the date the prescription is filled and the amount of your co-pay that will be paid for by using this card. For more information, please see the Glenmark Therapeutics Privacy Policy at www.glenmarktherapeutics.com.
For questions about the program please call 1.855.708.4613.
2019-DERM-CON-CP-01/v1/04-2019