The ALVESCO® (ciclesonide) Inhalation Aerosol Savings Program
Reduce out-of-pocket cost on
ALVESCO® (ciclesonide) Inhalation Aerosol*
Since reducing out-of-pocket cost is important, we have a special offer for you. The ALVESCO (ciclesonide) Savings Program can provide qualified patients ALVESCO for low out-of-pocket cost. This program can reduce
co-pays to as low as $17, saving patients up to $75 on each of their next 12 prescription fills each year.*
* Most insured patients will pay no more than $17 monthly with a maximum benefit of $75 per fill. Restrictions apply and co-pay amounts may vary. See full program rules and eligibility.
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In order to participate in the ALVESCO Savings Program, you must meet certain eligibility criteria. Please answer the following questions to continue:
* Program Rules – Patient Eligibility, Terms, and Conditions
- Valid only for qualified customers with a valid prescription for
ALVESCO® (ciclesonide) Inhalation Aerosol. No substitutions permitted.
- A parent or guardian must enroll in the ALVESCO Savings Program on behalf of a patient under 18 years of age.
- Not valid for prescriptions covered or paid for by Medicare (including true out-of-pocket expenses under Medicare Part D), Medicaid, or any other federal or state healthcare programs, such as state pharmaceutical assistance programs.
- Not valid for patients who are Medicare eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees (i.e., you are eligible for Medicare Part D but receive a prescription drug benefit through a former employer).
- Your discount with the ALVESCO Savings Program card
is valid to reduce your co-pay to $17 with a maximum
reduction of $75 per prescription. Discount available
on up to twelve (12) prescription fills for ALVESCO per
- Your acceptance of this offer must be consistent with the terms of any drug benefit provided by a health insurer, health
plan, or other third-party payor, and you agree to report
acceptance of this offer to your health insurer, health plan,
or third-party payor as may be required.
- Offer limited to one card per person, and may not be used with any other discount, coupon, or offer.
- Only an original ALVESCO Savings Program card or web-generated paper card will be accepted and must be
presented to your pharmacist at the time you have the
prescription filled—not valid if reproduced.
- Offer valid only in the United States. Void where prohibited by law, taxed, or restricted.
- Sunovion Pharmaceuticals Inc. reserves the right to change or discontinue this offer at any time without notice.
- By participating in this program, you the patient certify that (a) you have read the above terms; (b) you are not reimbursed, nor will you submit a claim for
reimbursement, nor will you seek to have any portion of this prescription counted toward your out-of-pocket costs (eg, TrOOP) under any federal, state, or private programs for this or other prescriptions for ALVESCO to which this offer will apply; and (c) you will otherwise comply with the terms above.
Using mail-order pharmacies
- Check with your mail-order pharmacy to see if they accept loyalty cards such as the ALVESCO Savings Program card (most of them do). If they do, all you need to do is submit a photocopy of your card along with your prescription and insurance card information.
- For mail-order pharmacies that do not accept loyalty cards, we will reimburse you $75. Please call 1-855-834-3458 or visit http://www.patientrebateonline.com to
request a form that you can fill out and return to us, along with a copy of your receipt. We will then issue you a check.