* Are you enrolled in any government, state or federally funded medical or prescription benefit program: this includes Medicare, Medicaid, Medigap, VA, DOD and TriCare as well as any other state or federal employee benefit programs?
* Your coupon and/or card is not valid for prescriptions purchased under Medicaid, Medicare or similar federal, state or other government funded benefit programs. Should you begin receiving prescription benefits from such a federal, state or government funded program at any time, you will no longer be eligible to participate in this program. We may contact you by phone or mail you periodically in order to verify that your eligibility for the program has not changed.Do you acknowledge your agreement with the above statement?
Sunovion Pharmaceuticals Inc. respects your personal health information and complies with applicable laws regarding the use of such information.
‡ALVESCO® (ciclesonide) Savings Program: 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 for eligibility, terms and conditions.
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