Eligible commercially insured patients with a valid prescription for Duaklir® Pressair® (aclidinium bromide/formoterol fumarate) who present this savings card at participating pharmacies will pay $10 per 30-day supply (1 inhaler) if their out-of-pocket cost is more than $10. For eligible patients without insurance please call the Circassia Connect Hotline at 1-844-892-7872. This offer is good for 12 uses and each inhaler counts as 1 use. Other restrictions may apply. Patient is responsible for applicable taxes, if any. Card expires on 12/31/2020. If patient has any questions regarding this offer, please call 1-844-892-7872.
Non-transferable, limited to one per person, cannot be combined with any other offer. Void where prohibited by law, taxed or restricted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer.
If a patient’s commercial insurance plan does not cover DUAKLIR PRESSAIR, use of this offer permits his/her healthcare provider or pharmacy to share limited information with certain Circassia vendors to determine if additional resources may be available, and to act on his/her behalf to initiate any processes that may be necessary to access these resources.
Pharmacist Instructions for a Patient With an Eligible Third-Party Payer: For Insured/Covered Patients: Submit the claim to the primary Third-Party Payer first, then submit the balance due to Change Healthcare as a Secondary Payer COB with patient responsibility amount and a valid Other Coverage Code of 8. This will reduce the eligible patient’s out-of-pocket costs to $10 on a 30-day supply.
You may be eligible for this offer if you are insured by commercial insurance and your insurance does not cover the full cost of your prescription or denies coverage of DUAKLIR PRESSAIR completely.
Patients who are enrolled in a state or federally funded prescription insurance program are not eligible for this offer. This includes patients enrolled in Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DOD) programs or TriCare, and patients who are Medicare eligible and enrolled in an employer-sponsored group waiver health plan or government-subsidized prescription drug benefit program for retirees.
If you are enrolled in a state or federally funded prescription insurance program, you may not use this savings card even if you elect to be processed as an uninsured patient.
This offer is not insurance, is restricted to residents of the United States and to patients over 18 years of age. If you use a mail-order pharmacy, please contact your pharmacy provider to confirm if this offer will be accepted.