Terms and Conditions | DILANTIN® (extended phenytoin sodium capsules, USP)

DILANTIN SAVINGS CARD TERMS AND CONDITIONS

By participating in the DILANTIN Savings Offer Program, you acknowledge that you currently meet the eligibility criteria and will comply with the terms and conditions described below:

  • Patients are not eligible to use this Savings Offer if they are enrolled in a state or federally funded insurance program, including but not limited to Medicare, Medicaid, TRICARE, Veteran Affairs healthcare, a state prescription drug assistance program, or the Government Health Insurance Plan available in Puerto Rico (formerly known as “La Reforma de Salud”)
  • Patient must have private insurance. This Savings Offer is not valid for cash-paying patients. The value of this Savings Offer is limited to $20 per use or the amount of your co-pay, whichever is less
  • This Savings Offer is not valid when the entire cost of your prescription drug is eligible to be reimbursed by your private insurance plans or other health or pharmacy benefit programs
  • You must deduct the savings received under this program from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf
  • You are responsible for reporting use of this Savings Offer to any private insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using this Savings Offer, as may be required. You should not use this Savings Offer if your insurer or health plan prohibits use of manufacturer Savings Offers
  • Eligible patients may save up to $20 per monthly prescription fill. By using this Savings Offer, eligible patients may receive a savings of up to $20 per fill off their co-pay or out-of-pocket costs. This Savings Offer is available for a maximum savings of $240 per year ($20 per month x 12 months). For a mail-order 3-month prescription, your total maximum savings may be $60 ($20 x 3)
  • This Savings Offer is not valid (i) for Massachusetts residents or (ii) for California residents whose prescriptions are covered, in whole or in part, by third-party insurance
  • This Savings Offer is not valid where prohibited by law
  • This Savings Offer cannot be combined with any other savings, free trial, or similar offer for the specified prescription
  • This Savings Offer will be accepted only at participating pharmacies
  • This Savings Offer is not health insurance
  • This Savings Offer may not be redeemed more than once per 30 days per patient
  • No other purchase is necessary
  • This Savings Offer is good only in the U.S. and Puerto Rico
  • This Savings Offer is limited to 1 per person during this offering period and is not transferable
  • Data related to your redemption of this Savings Offer may be collected, analyzed, and shared with Pfizer for market research and other purposes related to assessing Pfizer’s programs. Data shared with Pfizer will be aggregated and de-identified; it will be combined with data related to other Savings Offer redemptions and will not identify you
  • Pfizer reserves the right to rescind, revoke, or amend the program without notice
  • No membership fees. This Savings Offer and Program expire on 12/31/2021
  • For help with the DILANTIN Savings Offer, call 1-866-590-9400, visit DILANTIN.com, or write: Pfizer Inc., 235 E 42nd Street, New York, NY 10017

If your pharmacy does not participate, you may be able to submit a request for a rebate in connection with this Savings Offer. Pay for your DILANTIN prescription and mail copy of original pharmacy receipt (cash register receipt NOT valid) with product name, date, and amount circled to: PO Box 6875, Bridgewater, NJ 08807. Be sure to include a copy of the front of your DILANTIN Savings Card, your name, and mailing address. Please expect up to 4 to 6 weeks for reimbursement.

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