THIS SITE IS INTENDED
FOR US CONSUMERS

  • BEVESPI AEROSPHERE is a prescription medication used long-term to treat adults with COPD READ MORE...(chronic obstructive pulmonary disease), including chronic bronchitis, emphysema, or both. SHOW LESS
  • BEVESPI AEROSPHERE is not a rescue inhaler and is not for use to treat sudden COPD symptoms. READ MORE...It is not for use in asthma. SHOW LESS

YOU COULD GET
YOUR PRESCRIPTION FREE
GET YOUR
PRESCRIPTION FREE
FOR THE FIRST YEAR
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*For Commercially Insured Patients. Subject to eligibility rules; restrictions apply.

This BEVESPI AEROSPHERE savings offer is brought to you by .

 

Get BEVESPI AEROSPHERE Free for the First Year.*

You’re working hard to manage day-to-day life with a breathing condition. We’re committed to helping to make BEVESPI AEROSPHERE affordable so you can focus on what really matters—your breathing.

 

For eligible, commercially insured patients

If you’re a new patient, you could get your BEVESPI AEROSPHERE prescription filled FREE for up to 12 months—even if you have restrictions on your prescription benefit coverage.*

*Subject to eligibility rules; restrictions apply.

Interested?

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BEV_REG

Please fill out the short form below to get savings on BEVESPI AEROSPHERE. After submitting, you can start using your card right away.


AstraZeneca respects your personal health information. The information you provide may be used to send you health-related materials and to develop products, services, and programs. Third parties working on behalf of AstraZeneca may receive information that includes the date that you filled the prescription, the quantity of medication dispensed by your pharmacist, and your savings under the Program. AstraZeneca, or third parties working on our behalf, will not sell or rent personal health information. If in the future you no longer want to receive these materials, please call 1-800-236-9933.1-800-236-9933.

Please visit www.azprivacynotice.com to review our Privacy Notice.

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STEP 1 OF 2: GET STARTED

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STEP 2 OF 2: ENTER YOUR DETAILS

In order to participate in the savings program, please enter your details below.

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If you would like to receive your savings card through text message, please provide your mobile number to enroll in AZhelps for BEVESPI AEROSPHERE® (glycopyrrolate 9 mcg/formoterol fumarate 4.8 mcg) Inhalation Aerosol

 

Message and data rates may apply.

 
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By registering today, you will receive information about BEVESPI AEROSPHERE, and may receive information about other respiratory medicines and services related to your condition.

You must be at least 18 years of age.

 Yes, I would also like to receive information in the future about all AstraZeneca products, programs, and services that may be of interest to me.
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ELIGIBILITY

You may be eligible for this offer if you are insured by commercial insurance and your insurance does not cover the full cost of your prescription, or you are not insured and are responsible for the cost of your prescriptions.

Patients who are enrolled in a state or federally funded prescription insurance program are not eligible for this offer. This includes patients enrolled in Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DOD) programs or TriCare, and patients who are Medicare eligible and enrolled in an employer-sponsored group waiver health plan or government-subsidized prescription drug benefit program for retirees.

If you are enrolled in a state or federally funded prescription insurance program, you may not use this savings card even if you elect to be processed as an uninsured (cash-paying) patient.

This offer is not insurance, is restricted to residents of the United States and Puerto Rico, and to patients over 18 years of age. If you use a mail-order pharmacy, please contact your pharmacy provider to confirm if this offer will be accepted.

TERMS OF USE

Eligible commercially insured patients with a valid prescription for BEVESPI AEROSPHERE® (glycopyrrolate/formoterol fumarate) who present this savings card at participating pharmacies will receive 100% off their out-of-pocket costs for each 30-day supply (1 inhaler). If you pay cash for your prescription, you will receive up to $100 in savings on your out-of-pocket costs for each prescription. This offer is good for 12 uses and each inhaler counts as 1 use. Patient is responsible for applicable taxes, if any. Card expires on 12/31/17. If you have any questions regarding this offer, please call 1-877-469-18441-877-469-1844.

Non-transferable, limited to one per person, cannot be combined with any other offer. Void where prohibited by law, taxed or restricted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer.

AstraZeneca reserves the right to rescind, revoke, or amend this offer, eligibility and terms of use at any time without notice. This offer is not conditioned on any past, present or future purchase, including refills. Offer must be presented along with a valid prescription for BEVESPI AEROSPHERE® (glycopyrrolate/formoterol fumarate) at the time of purchase.

If your commercial insurance plan does not cover BEVESPI AEROSPHERE® (glycopyrrolate/formoterol fumarate), use of this offer permits your healthcare provider or pharmacy to share limited information with certain AstraZeneca vendors to determine if additional resources may be available to you; and to act on your behalf to initiate any processes that may be necessary to access these resources.

BY USING THIS CARD, YOU AND YOUR PHARMACIST UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

Pharmacist Instructions for a Patient With an Eligible Third-Party Payer: For Insured/Covered Patients: Submit the claim to the primary Third-Party Payer first, then submit the balance due to Therapy First Plus as a Secondary Payer COB with patient responsibility amount and a valid Other Coverage Code of 8. This will reduce the eligible patient’s out-of-pocket costs to $0 on a 30-day supply. For Insured/Not Covered Patients: Submit the claim to the primary Third-Party Payer first, if the primary claim submission shows a managed care restriction (step-edit, prior authorization or NDC block), continue the claim adjudication process and submit the balance due to Therapy First Plus as a Secondary Payer COB with patient responsibility amount and a valid Other Coverage Code of 3. This will reduce an eligible patient’s out-of-pocket costs to $0 on a 30-day supply. Reimbursement will be received from Therapy First Plus.

Pharmacist Instructions for a Cash-Paying Patient: Submit this claim to Therapy First Plus. A valid Other Coverage Code (eg, 1) is required. The card will cover up to $100 per 30-day supply. Reimbursement will be received from Therapy First Plus. Valid Other Coverage Code Required. For any questions regarding Therapy First Plus online processing, please call the Help Desk at 1-800-422-56041-800-422-5604. Program managed by PSKW, LLC, on behalf of AstraZeneca.

IMPORTANT SAFETY INFORMATION ABOUT BEVESPI AEROSPHERE INCLUDING BOXED WARNING

People with asthma who take long-acting beta2-adrenergic agonist (LABA) medicines, such as formoterol fumarate (one of the medicines in BEVESPI AEROSPHERE), have an increased risk of death from asthma problems. It is not known if LABA medicines increase the risk of death in people with COPD. BEVESPI AEROSPHERE is only approved for use in COPD. BEVESPI AEROSPHERE is not approved for use in asthma.

  • Call your healthcare provider if breathing problems worsen over time while using BEVESPI AEROSPHERE
  • Get emergency medical care if your breathing problems worsen quickly or if you use your rescue inhaler, but it does not relieve your breathing problems
  • Do not use BEVESPI AEROSPHERE to treat sudden symptoms of COPD. Always have a rescue inhaler with you to treat sudden symptoms
  • BEVESPI AEROSPHERE is not for the treatment of asthma. It is not known if BEVESPI AEROSPHERE is safe and effective in people with asthma
  • Do not use BEVESPI AEROSPHERE if you are allergic to glycopyrrolate, formoterol fumarate, or to any of the ingredients in BEVESPI AEROSPHERE
  • Do not use BEVESPI AEROSPHERE more often than prescribed
  • Do not take BEVESPI AEROSPHERE with other medicines that contain a LABA or an anticholinergic for any reason. Tell your healthcare provider about all the medicines you take
  • Tell your healthcare provider about all your medical conditions including heart problems, high blood pressure, seizures, thyroid problems, diabetes, liver problems, glaucoma, prostate or bladder problems, or problems passing urine

BEVESPI AEROSPHERE can cause serious side effects, including:

  • Sudden breathing problems immediately after inhaling your medicine
  • Serious allergic reactions. Call your healthcare provider or get emergency medical care if you get any of the following symptoms of a serious allergic reaction: rash; hives; swelling of the face, mouth and tongue; breathing problems
  • Fast or irregular heartbeat, increased blood pressure, chest pain
  • Tremor or nervousness
  • New or worsened eye problems, including acute narrow-angle glaucoma. Symptoms may include: eye pain or discomfort, nausea or vomiting, blurred vision, seeing halos or bright colors around lights, and red eyes. If you have these symptoms, call your healthcare provider right away before taking another dose
  • New or worsened urinary retention. Symptoms may include difficulty urinating, painful urination, urinating frequently, or urinating in a weak stream or drips. If you have any of these symptoms, stop taking BEVESPI AEROSPHERE and call your healthcare provider right away
  • High blood sugar or low blood potassium

Common side effects of BEVESPI AEROSPHERE include urinary tract infection and cough. Tell your healthcare provider about any side effect that bothers you or that does not go away.

APPROVED USES

BEVESPI AEROSPHERE is a prescription medicine used to treat chronic obstructive pulmonary disease (COPD). COPD includes chronic bronchitis, emphysema, or both. BEVESPI AEROSPHERE is used long term as 2 inhalations, 2 times each day in the morning and in the evening, to improve symptoms of COPD for better breathing. Do not use BEVESPI AEROSPHERE to treat sudden symptoms of COPD; it won't replace a rescue inhaler. BEVESPI AEROSPHERE is not for the treatment of asthma.

Please read full Prescribing Information , including Boxed WARNING, and Medication Guide and Instructions for Use for BEVESPI AEROSPHERE.

IMPORTANT SAFETY INFORMATION ABOUT BEVESPI AEROSPHERE INCLUDING BOXED WARNING

People with asthma who take long-acting beta2-adrenergic agonist (LABA) medicines, such as formoterol fumarate (one of the medicines in BEVESPI AEROSPHERE), have an increased risk of death from asthma problems. It is not known if LABA medicines increase the risk of death in people with COPD.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.FDA.gov/medwatch or call 1-800-FDA-1088.1-800-FDA-1088.

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The information on this Web site should not take the place of talking with your doctor or health care professional. If you have any questions about your condition, or if you would like more information about BEVESPI AEROSPHERE or COPD, talk to your doctor or pharmacist. Only you and your doctor can decide if BEVESPI AEROSPHERE is right for you.