INTRAROSA® (prasterone) SUPPORT PROGRAM TERMS
- By opting into the INTRAROSA (prasterone) Support Program ("Program"), in which you can receive your Copay Savings Card via text, you consent to receive approximately 5 text messages and/or push notifications per month from AMAG Pharmaceuticals. Such messages may be marketing or non-marketing messages and may include, for example, refill reminders, fill confirmation, website information, etc. T-Mobile is NOT liable for delayed or undelivered messages.
- To stop receiving text messages, text STOP to 267-89. DOING SO WILL ONLY OPT YOU OUT OF THE INTRAROSA (prasterone) Support Program; you will remain opted in to any other AMAG Pharmaceuticals text message program(s) to which you separately opted in. You may unsubscribe from the digital wallet message Program at any time by disabling push notifications or removing the digital wallet pass from your device for digital wallet programs.
- To request more information or to obtain help, text HELP to 267-89. You can also call customer service at 1-877-411-2510.
- You represent that you are the account holder for the mobile telephone number(s) that you provide to opt in to the texting program. You are responsible for notifying AMAG Pharmaceuticals immediately if you change your mobile telephone number. You may notify AMAG Pharmaceuticals of a number change by re-enrolling in the program.
- Message and data rates may apply to each text message sent or received in connection with the texting program, as provided in your mobile telephone service rate plan, in addition to any applicable roaming charges. Charges are both billed and payable to your mobile service provider or deducted from your prepaid account. AMAG Pharmaceuticals does not impose a separate fee for sending text messages.
- Data obtained from you in connection with this Short Message Service (SMS) texting program may include your telephone number; your carrier's name; and the date, time, and content of your messages. AMAG Pharmaceuticals may use this information to contact you and to provide the services you request from us.
- AMAG Pharmaceuticals will not be liable for any delays in the receipt of any SMS messages, as delivery is subject to effective transmission from your network operator.
- The service is available only on these US participating mobile carriers: Verizon Wireless, Sprint, Nextel, Boost Mobile, T-Mobile, AT&T, Alltel, ACS Wireless, Bluegrass Cellular, Carolina West Wireless, Cellcom, Cellular One of East Central Illinois (ECIT), Cincinnati Bell, Cricket Wireless, C Spire Wireless, Duet IP (AKA Max/Benton/Albany), Element Mobile, Epic Touch, GCI Communication, Golden State Cellular, Hawkeye (Chat Mobility), Hawkeye (NW Missouri Cellular), Illinois Valley Cellular (IVC), Inland Cellular, iWireless, Keystone Wireless (Immix/PC Management), MetroPCS, Mobi PCS, Mosaic Telecom, MTPCS/Cellular One (Cellone Nation), Nex-Tech Wireless, nTelos, Panhandle Telecommunications, Pioneer, Plateau, Revol Wireless, Rina-Custer, Rina-All West, Rina-Cambridge Telecom Coop, Rina-Eagle Valley Comm, Rina-Farmers Mutual Telephone Co, Rina-Nucla Nutria Telephone Co, Rina-Silver Star, Rina-South Central Comm, Rina-Syringa, Rina-UBET, Rina-Manti, Simmetry Wireless, South Canaan (Cellular One of NEPA), Thumb Cellular, Union Wireless, United Wireless, U.S. Cellular, Viaero Wireless, Virgin Mobile, West Central Wireless (includes Five Star Wireless).
- You agree to indemnify AMAG Pharmaceuticals and parties texting on its behalf in full for all claims, expenses, and damages related to or caused in whole or in part by your failure to notify us if you change your telephone number, including but not limited to all claims, expenses, and damages related to or arising under the Telephone Consumer Protection Act.
- AMAG Pharmaceuticals may suspend or terminate your receipt of text messages if it believes you are in breach of these SMS Terms and Conditions. Your receipt of text messages is also subject to termination in the event that your mobile telephone service terminates or lapses. AMAG Pharmaceuticals reserves the right to modify or discontinue, temporarily or permanently, all or any part of the text messaging services you receive, with or without notice.
- AMAG Pharmaceuticals may revise, modify, or amend these SMS Terms and Conditions at any time. Any such revision, modification, or amendment shall take effect when it is posted to AMAG Pharmaceuticals's website. You agree to review these SMS Terms and Conditions periodically to ensure that you are aware of any changes. Your continued consent to receive text messages will indicate your acceptance of those changes.
SAVINGS CARD TERMS AND CONDITIONS
Eligible commercially insured patients pay no more than $35 copay for each 28-day supply of INTRAROSA for up to 12 months. Limitations apply. Each copay card may be used once every 28 days for up to 12 uses or program expiration, whichever occurs first. A valid prescriber ID# is required on the prescription. Any remaining out-of-pocket expense will be the patient's responsibility.
Patient Instructions: In order to redeem this offer, you must have a valid prescription for INTRAROSA. Follow the dosage instructions given by the doctor. This offer may not be redeemed for cash and is not insurance. By using this offer, you are certifying that you meet the eligibility criteria and will comply with the terms and conditions described in the Restrictions section below. Patients with questions about the INTRAROSA Savings offer should call 1-844-492-9898.
Pharmacist: When you apply this offer, you are certifying that you have not submitted a claim for reimbursement under any federal, state, or other governmental programs for this prescription. Participation in this program must comply with all applicable laws and regulations as a pharmacy provider. By participating in this program, you are certifying that you will comply with the terms and conditions described in the Restrictions section below.
Pharmacist Instructions for a Patient With an Eligible Third-Party Payer: Submit the claim to the primary Third-Party Payer first, then submit the balance due to Argus as a Secondary Payer as a copay only billing using BIN# 019158 and a valid Other Coverage Code (eg, 8). Eligible commercially insured patients pay no more than $35 copay for each 28-day supply of INTRAROSA for up to 12 months. Limitations apply. Reimbursement will be received from Argus. Valid Other Coverage Code required. For any questions regarding Argus online processing, please call the Help Desk at 1-844-373-0987.
Restrictions: This offer is valid in the United States and Puerto Rico for commercially insured patients 18 years of age or older. Offer not valid for prescriptions reimbursed under Medicaid, Medicare, TRICARE, VA, DOD, or other federal or state health programs (such as medical assistance programs). If the patient is eligible for drug benefits under any such program, the patient cannot use this offer. By using this offer, the patient certifies that he or she will comply with any terms of his or her health insurance contract requiring notification to his or her payer of existence and/ or value of this offer. It is illegal to (or offer to) sell, purchase, or trade this offer. Program expires 12/31/2019. This offer is not transferable and is limited to one offer per person. Not valid if reproduced. Void where prohibited by law. Program managed by ConnectiveRx on behalf of AMAG Pharmaceuticals, Inc. The parties reserve the right to rescind, revoke, or amend this offer without notice at any time.