Please answer the following questions.

Do you live in the United States or Puerto Rico?

Do you have commercial prescription drug insurance?

By activating your card, you certify that the above information is true and correct and that you are not enrolled in a federal- or state-funded prescription drug benefit program, such as Medicare or 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 agree to this certification and I accept the Program Terms, Conditions, and Eligibility Criteria, which I have read here.

Please click here for full Prescribing Information,
including Boxed Warning.