The Qsymia Savings Card

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QSYMIA SAVINGS CARD — PATIENT ELIGIBILITY, TERMS AND CONDITIONS

Eligible patients for the monthly savings offer must reside in the United States, Washington, DC, Puerto Rico, Virgin Islands, or Guam, and be 18 years or older. If the eligible patient is 12-17 years of age, a caregiver must sign up on their behalf. This offer is limited to one per patient and may not be combined with any other offer. VIVUS LLC reserves the right to modify or discontinue these offers at any time without notice.

Prescriptions for Qsymia are redeemable only through Qsymia-certified pharmacies. Patients or caregivers are responsible for any sales tax. Patients or caregivers may not submit a claim for the amounts covered by the offer for payment to any third-party payers, including a flexible spending account (FSA), a Health Savings Account (HSA), or a Health Reimbursement Account (HRA). Patients or caregivers are responsible for reporting receipt of program benefit to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled, as may be required.

The Monthly Savings Offer card requires an activated Program ID prior to use.

A valid prescription for Qsymia is required at the time of redemption. No substitutions permitted.

Not available for individuals enrolled in any government-funded insurance program that covers prescription drugs (for example, Medicaid, Medicare, TRICARE, VA, Department of Defense, Indian Health Service) or where prohibited by law.

Patients paying cash or patients whose commercial insurance coverage does not cover Qsymia, are eligible to receive $75 off quantities of 28-30 days for up to 100 subsequent fills. Both of these groups are eligible to receive $70 off 3.75 mg/23 mg dose quantities of 14-15 days for up to 10 subsequent fills. Please note that quantity claims of 16-27 days will be rejected.

Commercially-insured patients with coverage for Qsymia are required to cover the first $70 of the copay. For quantities of 28-30 days, these patients are eligible to receive $65 off for up to 100 subsequent fills. For 3.75 mg/23 mg dose quantities of 14-15 days, these patients are eligible to receive $65 off for up to 10 subsequent fills. Please note that quantity claims of 16-27 days will be rejected.

It is illegal to sell, purchase, trade, or counterfeit, or offer to sell, purchase, trade, or counterfeit the cards. Void where prohibited by law, taxed, or restricted.

What is Qsymia?

Qsymia is a prescription medicine that contains phentermine and topiramate extended-release. Qsymia may help adults and children 12 years and older with obesity, or some…

Important Safety Information

Do not take Qsymia if you are pregnant, planning to become pregnant, or become pregnant during Qsymia treatment; have glaucoma; have thyroid problems (hyperthyroidism); are taking certain medicines called monoamine oxidase inhibitors…

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