How to Use Your DILANTIN $4 Co-Pay Card*

Activate your Co-Pay Card by calling 1-866-590-9400. Take your DILANTIN $4 Co-Pay Card to any participating pharmacy to get your prescription or refill of brand-name DILANTIN. Keep your card and use it to save on future brand-name DILANTIN prescriptions. You can also use your Card when you refill by mail.

Common Questions About Your Card

How does the DILANTIN $4 Co-Pay Card work at a retail pharmacy?
Give your DILANTIN $4 Co-Pay Card to the pharmacist each time you fill your prescription. By using the Card, you will pay a minimum of $4 per fill and receive savings of up to $50 per fill, for a maximum savings of $600 per card. Use your Card every time you fill your brand-name DILANTIN prescription. The Card is good until 12/31/14.

How does the DILANTIN $4 Co-Pay Card work for mail-order patients?
Mail-in redemptions have different terms and conditions from pharmacy redemptions. Patients who receive their prescription via a mail-order pharmacy program, for a 90-day supply, will pay the first $10 of the 90-day supply. Pfizer will pay the remaining amount, up to $150, or the amount of your co-pay, for a maximum savings of $600 per card. The Card is good until 12/31/14. For a 60-day supply, patients will pay the first $8 of the 60-day supply, and Pfizer will pay the remaining amount, up to $100 or the amount of your co-pay, for a maximum savings of $600 per card. The Card is good until 12/31/14. For each mail-order supply, patients may request reimbursement via a mail-in rebate.

• Make a copy of your pharmacy receipt (cash register receipt not valid)
• Circle the product name, date, and price
• Make a copy of the front of your DILANTIN $4 Co-Pay Card and write your name and address at the top
• Mail to the address below:
  
  Pfizer, Attn: DILANTIN
  780 Township Line Road
  Yardley, PA 19067

How much will I save?
By using the Card, patients receive savings of up to $50 per fill. The Card is good for a maximum savings of $600 per card. Patients who receive their prescription via a mail-order pharmacy program, for a 90-day supply, will pay the first $10 of the 90-day supply. Pfizer will pay the remaining amount, up to $150, or the amount of co-pay, for a maximum savings of $600 per card. For a 60-day supply, patients pay the first $8 of the 60-day supply, and Pfizer will pay the remaining amount, up to $100 or the amount of co-pay, for a maximum savings of $600 per card. The Card can be used for every brand-name DILANTIN prescription and refill. The Card is good until 12/31/14.

I don't have prescription drug coverage or insurance. Can I still participate in the DILANTIN $4 Co-Pay Card offer?
Yes, even if you pay for your medicine without an insurance plan, you can use the Card to purchase brand-name DILANTIN. But only if you are eligible.*

What happens after the date on the Card has passed?
Once the date on the Card has passed, you can no longer use the Card.

Can I use the Card in conjunction with other rebates?
No. The DILANTIN $4 Co-Pay Card can't be combined with any other rebate, coupon, free trial, or savings offer on the same prescription.

My pharmacist couldn't process my DILANTIN $4 Co-Pay Card. How do I get reimbursed?
If you've already filled your prescription, you may receive reimbursement via a mail-in rebate.

• Make a copy of your pharmacy receipt (cash register receipt not valid)
• Circle the product name, date, and price
• Make a copy of the front of your DILANTIN $4 Co-Pay Card and write your name and address at the top
• Mail these items to the address below:
  
  Pfizer, Attn: DILANTIN
  780 Township Line Road
  Yardley, PA 19067

Can I use the DILANTIN $4 Co-Pay Card for other medications I'm taking?
The Card can only be used for brand-name DILANTIN prescriptions.

Can I use this card to receive a generic version of extended phenytoin sodium capsules, USP?
No, the Card is only eligible for brand-name DILANTIN. Only your doctor can recommend changing your medication. When a change in the dosage form or brand is prescribed, careful monitoring of phenytoin serum levels should be carried out by your doctor.

My Card is damaged. How can I get a new one?
If your Card is damaged, you can re-register for a new one.

What if I lose my Card? How can I get a new one?
If your Card is lost, you can re-register for a new one.

Is there a minimum number of tablets I need to purchase to use the Card?
The minimum quantity for redemption is 30 tablets.

How often can the Card be redeemed?
The DILANTIN $4 Co-Pay Card can be redeemed for each fill up to a maximum savings of $600 per card.

How quickly can I use the Card after I've printed it or received it in the mail?
Once you have your Card, it will be ready to use right away with a brand-name DILANTIN prescription. No membership fees apply. The Card is not health insurance. The Card is accepted only at participating pharmacies. For questions about the Card, please call 1-866-590-9400.

The Card cannot be used with Medicare or Medicaid. It is not valid for residents of Massachusetts. Limit one per person. See Terms and Conditions for more information.

INDICATION

DILANTIN (extended phenytoin sodium capsules, USP) is a prescription medicine used to treat tonic-clonic (grand mal), complex partial (psychomotor or temporal lobe) seizures, and to prevent and treat seizures that happen during or after brain surgery.

IMPORTANT SAFETY INFORMATION

Do not take DILANTIN if you are allergic to phenytoin or its inactive ingredients or other anticonvulsants such as CEREBYX (fosphenytoin), PEGANONE (ethotoin), or MESANTOIN (mephenytoin).

You should not take delavirdine (a drug which may be prescribed to you when you suffer from an HIV infection) with DILANTIN since DILANTIN modifies its effect.

Do not stop taking DILANTIN without first talking to your healthcare provider. Stopping DILANTIN suddenly can cause serious problems. Stopping a seizure medicine suddenly in a patient who has epilepsy can cause seizures that will not stop (status epilepticus).

Do not change your dose of DILANTIN without talking to your healthcare provider. Only your doctor can recommend changing your medication. When a change in the dosage form or brand is prescribed, careful monitoring of phenytoin serum levels should be carried out by your doctor.

Like other antiepileptic drugs, DILANTIN may cause suicidal thoughts or actions in a very small number of people, about 1 in 500. Before you take DILANTIN, tell your healthcare provider if you have or have had depression, mood problems, or suicidal thoughts or behavior. Call a healthcare provider right away if you have thoughts about suicide or dying, attempts to commit suicide, new or worse depression, new or worse anxiety, feeling agitated or restless, panic attacks, trouble sleeping (insomnia), new or worse irritability, acting aggressive, being angry, or violent, acting on dangerous impulses, an extreme increase in activity and talking (mania), other unusual changes in behavior or mood.

If you experience a rash while taking DILANTIN, or any of the symptoms listed below, contact your doctor immediately.
DILANTIN can cause a serious, life-threatening disorder called Stevens-Johnson syndrome and Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) which can be fatal.
DILANTIN can cause swollen glands (lymph nodes).
DILANTIN can cause allergic reactions or serious problems, which may affect organs and other parts of your body like the liver or blood cells. You may or may not have a rash with these types of reactions.
DILANTIN may cause softening of your bones (osteopenia, osteoporosis, and osteomalacia). This can cause broken bones.
DILANTIN can cause overgrowth of your gums. Brushing and flossing your teeth and seeing a dentist regularly while taking DILANTIN can help prevent this.

Before you take DILANTIN, inform your doctor of any medical conditions you have.
Tell your healthcare provider if you have or had porphyria (por-FER-ee-ah).
DILANTIN has been associated with harmful effects on blood cells.
Tell your healthcare provider if you have liver problems as you may show early signs of toxicity.
DILANTIN may cause liver damage.

Before you take DILANTIN, tell your healthcare provider if you have or had diabetes. Your blood sugar level can be altered while taking DILANTIN.

If you take DILANTIN during pregnancy, your baby is also at risk for serious birth defects and bleeding problems right after birth. Your healthcare provider may give you and your baby medicine to prevent this. Tell your doctor if you are breastfeeding or plan to breastfeed. DILANTIN can pass into breast milk.

Taking DILANTIN with certain other medicines can cause side effects or affect how well they work. Do not start or stop other medicines without talking to your healthcare provider.

Do not drink alcohol while you take DILANTIN without first talking to your healthcare provider. Drinking alcohol while taking DILANTIN may change your blood levels of DILANTIN which can cause serious problems.

The most common side effects of DILANTIN include problems with walking and coordination, slurred speech, confusion, dizziness, trouble sleeping, nervousness, tremor, headache, and nausea.

All brands are trademarks of their owners.

Please see Full Prescribing Information, including Medication Guide.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-332-1088.

Terms and Conditions

By using the DILANTIN $4 Co-Pay Card, you acknowledge that you currently meet the eligibility criteria and will comply with the following terms and conditions.

• The Card is not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare, or other federal or state healthcare programs (including any state prescription drug assistance programs and the Government Health Insurance Plan available in Puerto Rico [formerly known as "La Reforma De Salud"])
• The Card is not valid for prescriptions that are eligible to be reimbursed by private insurance plans or other health or pharmacy benefit programs that reimburse you for the entire cost of your prescription drugs
• You must be 18 or older
• By using the Card, you will pay a minimum of $4 per fill and receive savings of up to $50 per fill, for a maximum savings of $600 per card
• You must deduct the value received under this program from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf
• The Card is not valid for Massachusetts residents whose prescriptions are covered in whole or in part by third-party insurance, or where otherwise prohibited by law
• The Card cannot be combined with any other rebate or coupon, free trial, or similar offer for the specified prescription
• The Card will be accepted only at participating pharmacies
• The Card is not health insurance
• This offer is good only in the United States and Puerto Rico
• The Card is limited to one per person during this offering period and is not transferable
• Pfizer reserves the right to rescind, revoke, or amend the Card without notice
• Offer expires 12/31/14

No membership fees apply. For help with the DILANTIN $4 Co-Pay Card, call 1-866-590-9400. Pfizer Inc, DILANTIN, 235 East 42nd Street, New York, NY 10017.