SANCUSO Copay Assistance Card Program


  1. Show the Copay Assistance Card and your valid prescription each time you pay for your prescription.
  2. Pay the initial $20 of your copay for each prescription of Sancuso then any remaining out-of-pocket cost will be reduced by up to $150 per month.*
  3. Save your Copay Assistance Card—this card can be used twice a month for up to 24 prescriptions or 48 patches per patient, whichever comes first. Maximum 4 patches per month. In no case will the monthly benefit exceed $150.
What you pay:
Out-of-Pocket Cost - Copay Card Pays = You Pay
$75   $55   $20
$170   $150   $20
$250   $150   $100
*Offer expires 01/31/2017. This offer is not valid for Medicare, Medicaid, VA, or
DOD patients. Please see back of the card for more program details.

FARESTON Copay Assistance Card Program


  1. Show the Copay Assistance Card and your valid prescription each time you pay for your prescription.
  2. Pay the initial $20 of your copay. Any remaining out-of-pocket costs will be reduced by up to $150 per month.
  3. Save your Copay Assistance Card—this card can be used once a
    month for up to 12 prescriptions. In no case will the monthly benefit
    exceed $150.
What you pay:
Out-of-Pocket Cost - Copay Card Pays = You Pay
$75   $55   $20
$170   $150   $20
$250   $150   $100
Please see important safety information listed on the back of the card, including boxed warning. Offer expires 01/31/2017. This offer is not valid for Medicare, Medicaid, VA or DOD patients. Please see back of the card for more program details.
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