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To the pharmacist:

For processing assistance, please call McKesson
Pharmacy Support at 1-866-279-4730.

Group: 50776822

ID: 9008219393

Eligibility and Terms of Use for $10 Co-pay Card

ELIGIBILITY REQUIREMENTS:

You may be eligible for the Co-pay Card for ELIQUIS^® (apixaban) if:

1.You are insured by commercial insurance and your prescription insurance coverage does not cover the full cost of your prescription, that is, you have a co-pay obligation for ELIQUIS;
2.You do not have prescription insurance coverage through a state or federal healthcare program, including but not limited to Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), or Department of Defense (DOD) programs; patients who move from commercial plans to state or federal healthcare programs will no longer be eligible;
3.You are 18 years of age or older; and
4.You are a resident of the United States, Puerto Rico, or other select U.S. Territory.

1.Eligible patients who present an activated Co-pay Card together with a valid prescription for ELIQUIS at participating pharmacies may pay as little as $10 per 30-day supply (up to 74 tablets for the first fill and up to 60 tablets for all subsequent fills) for up to 24 months, subject to a maximum annual benefit of $6,400. Other restrictions may apply. Patient is responsible for applicable taxes, if any.
2.Offer not applicable to co-pays of $10 or less.
3.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.
4.Your acceptance of this offer confirms that this offer is consistent with your insurance and that you will report the value received as may be required by your insurance provider.
5.Card must be activated before use. Activation and first use of the Co-pay Card must take place by December 31, 2024. Card expires 24 months from activation. Upon expiration, eligible patients may re-enroll in the Co-pay Card Program.
6.All Program payments are for the benefit of the patient only.
7.Only valid in the United States, Puerto Rico, and other select U.S. Territories; this offer is void where restricted or prohibited by law.
8.This offer is non-transferable, no substitutions are permissible, and offer cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription.
9.The Co-pay Card may not be sold, purchased, traded, or counterfeited. Reproductions of this Co-pay Card are void.
10.Bristol-Myers Squibb and Pfizer reserve the right to rescind, revoke, or amend this offer at any time without notice.
11.This offer is not conditioned on any past, present, or future purchase, including refills.
12.No membership fees.
13.The Co-pay Card for ELIQUIS is not health insurance.
The Co-pay Card will be accepted only at participating pharmacies. For those customers using mail order or any non-participating retail pharmacy, please call 866-279-4730 to request a patient rebate form, or go to www.patientrebateonline.com to download a form.

Questions can also be submitted via mail to:

P.O. Box 2914

Phoenix, AZ 85062-2914

BY USING THIS CARD, YOU AND YOUR PHARMACIST UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

Please see Full Prescribing Information, including Boxed WARNINGS and Medication Guide.

Indications

ELIQUIS (apixaban) is a prescription medicine used to reduce the risk of stroke and blood clots in people who have atrial fibrillation, a type of irregular heartbeat, not caused by a heart valve problem.

ELIQUIS is a prescription medicine used to treat blood clots in the veins of your legs (deep vein thrombosis) or lungs (pulmonary embolism), and reduce the risk of them occurring again.

ELIQUIS is a prescription medicine used to reduce the risk of forming a blood clot in the legs and lungs of people who have just had hip or knee replacement surgery.

Important Safety Information

For people taking ELIQUIS^® (apixaban) for atrial fibrillation: Do not stop taking ELIQUIS without talking to the doctor who prescribed it for you. Stopping ELIQUIS increases your risk of having a stroke.

ELIQUIS may need to be stopped prior to surgery or a medical or dental procedure. Your doctor will tell you when you should stop taking ELIQUIS and when you may start taking it again. If you have to stop taking ELIQUIS, your doctor may prescribe another medicine to help prevent a blood clot from forming.

ELIQUIS can cause bleeding, which can be serious, and rarely may lead to death. This is because ELIQUIS is a blood thinner medicine that reduces blood clotting.

You may have a higher risk of bleeding if you take ELIQUIS and take other medicines that increase your risk of bleeding, such as aspirin, nonsteroidal anti-inflammatory drugs (called NSAIDs), warfarin, heparin, selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs), and other medicines to help prevent or treat blood clots. Tell your doctor about all of the medicines you take, including any over-the-counter medicines, vitamins, and herbal supplements.

While taking ELIQUIS, you may bruise more easily and it may take longer than usual for any bleeding to stop.

Call your doctor or get medical help right away if you have any of these signs or symptoms of bleeding when taking ELIQUIS:

unexpected bleeding or bleeding that lasts a long time, such as unusual bleeding from the gums, nosebleeds that happen often, or menstrual or vaginal bleeding that is heavier than normal
bleeding that is severe or you cannot control
red, pink, or brown urine; red or black stools (looks like tar)
coughing up or vomiting blood or vomit that looks like coffee grounds
unexpected pain, swelling, or joint pain
headaches, or feeling dizzy or weak

ELIQUIS (apixaban) is not for patients with artificial heart valves.

Spinal or epidural blood clots (hematoma). People who take ELIQUIS, and have medicine injected into their spinal and epidural area, or have a spinal puncture have a risk of forming a blood clot that can cause long-term or permanent loss of the ability to move (paralysis). Your risk of developing a spinal or epidural blood clot is higher if:

a thin tube called an epidural catheter is placed in your back to give you certain medicine
you take NSAIDs or a medicine to prevent blood from clotting
you have a history of difficult or repeated epidural or spinal punctures
you have a history of problems with your spine or have had surgery on your spine

If you take ELIQUIS and receive spinal anesthesia or have a spinal puncture, your doctor should watch you closely for symptoms of spinal or epidural blood clots or bleeding. Tell your doctor right away if you have tingling, numbness, or muscle weakness, especially in your legs and feet.

ELIQUIS is not for use in people with antiphospholipid syndrome (APS), especially with positive triple antibody testing, who have a history of blood clots.

Do not take ELIQUIS if you currently have certain types of abnormal bleeding or have had a serious allergic reaction to ELIQUIS.

Before you take ELIQUIS, tell your doctor if you have kidney or liver problems, have antiphospholipid syndrome, have any other medical condition, or have ever had bleeding problems. Tell your doctor if you are pregnant or breastfeeding, or plan to become pregnant or breastfeed. You and your doctor should decide if you will take ELIQUIS or breastfeed. You should not do both. Females who are able to become pregnant: talk with your healthcare provider about pregnancy planning, and your risk of severe uterine bleeding if you are treated with blood thinner medicines, including ELIQUIS.

Take ELIQUIS exactly as prescribed by your doctor. Take ELIQUIS twice every day with or without food, and do not change your dose or stop taking it unless your doctor tells you to. If you miss a dose of ELIQUIS, take it as soon as you remember, and do not take more than one dose at the same time. If you are taking ELIQUIS for atrial fibrillation, stopping ELIQUIS may increase your risk of having a stroke. Do not run out of ELIQUIS. Refill your prescription before you run out. When leaving the hospital following hip or knee replacement, be sure that you will have ELIQUIS available to avoid missing any doses.

Possible serious side effects include bleeding or a reaction to ELIQUIS itself. A reaction to ELIQUIS can cause hives, rash, itching, and possibly trouble breathing. If you get this reaction, it will usually happen soon after you take a dose of ELIQUIS. Get medical help right away if you have sudden chest pain or chest tightness, have sudden swelling of your face or tongue, have trouble breathing, wheezing, or feeling dizzy or faint.