With this Patient Savings Card, you pay the first $25 of your Keppra XR™ or
Keppra® co-pay, and we pay the remaining out-of-pocket expense up
to $30. And, since the Patient Savings Card is valid for each of your next 12 prescriptions,
that’s a savings of up to $360 per year!
To participate in the Keppra XR™ or Keppra® Patient Savings
Program, print this page and present it to the pharmacist along with your prescription.
If you have any questions regarding your eligibility or benefits or if you wish
to discontinue your participation, call the Keppra XR™/Keppra®
Patient Savings Program at 1-800-657-7613 (8:00 AM
- 8:00 PM EST, Monday-Friday).
Please do not cut out the card as important instructions for your pharmacist are
included on the printed page.
RxBIN:
610524
RxPCN:
Loyalty
RxGRP:
50775312
ISSUER:
(80840)
ID:
85236285
Eligibility Criteria
- Most patients who have commercial prescription insurance can benefit from the Keppra
XR™/Keppra® Patient Savings Program.
- Patients receiving prescription reimbursement under Medicare, Medicaid, and similar
federal or state programs are not eligible for this program. This includes patients
who are enrolled in a Medicare Part D prescription drug program. Additionally, this
program is not valid for residents of Massachusetts and where prohibited by law.
Pharmacist Instructions
- Submit transaction to McKesson Specialty Arizona Inc. using BIN #610524.
- If primary coverage exists, input card information as secondary coverage and transmit
using the COB segment of the NCPDP transaction. Applicable discounts will be displayed
in the transaction response.
- Acceptance of this card and your submission of claims for the Keppra XR™/Keppra®
Patient Savings Program are subject to the LoyaltyScript® program
Terms and Conditions established by McKesson Specialty Arizona Inc. By accepting
this card, you agree to the LoyaltyScript® program Terms and Conditions
posted at www.mckesson.com.
- Patient is not eligible if prescriptions are paid in part or full by any state-
or federally-funded programs, including but not limited to Medicare or Medicaid,
Medigap, VA, DOD, or TriCare, and where prohibited by law. LoyaltyScript®
is not an insurance card.
- For questions, call the Keppra XR™/Keppra® Patient Savings
Program at 1-800-657-7613.
Next: Keppra XR™ FAQs