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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
Get your prescription FREE* with our Zero-Pay program
*Subject to eligibility rules; restrictions apply.
GET YOUR PRESCRIPTION FREE* WITH OUR ZERO-PAY GUARANTEE PROGRAM GET YOUR PRESCRIPTION FREE* WITH OUR ZERO-PAY PROGRAM
*†For Commercially Insured Patients. Subject to eligibility rules; restrictions apply.This BEVESPI AEROSPHERE savings offer is brought to you by 
.
START SAVING NOW!
Here’s your savings card for your FREE* prescription, brought to you by AZhelps.
†Eligibility Requirements
Print your card and present it to your pharmacist to get your prescription FREE* for up to 12 months with our Zero-Pay program.
Print your card and present it to your pharmacist to get your prescription FREE* for up to 12 months with our Zero-Pay program.
- BIN# 004682
- PCN# CN
- GRP# EL57029049
- ID# XXXXXXXXXXXX
Please see full BEVESPI AEROSPHERE Prescribing Information including Boxed WARNING and Medication Guide.
Would you like to receive the saving card details via email?
GO MOBILE to use Apple Wallet or Google pay to add Savings card to add the savings card to Apple Wallet or Google Pay
GET YOUR SAVINGS CARD THROUGH TEXT MESSAGE
You can also get your savings card by texting FREE to 99789† for a coupon code sent directly to your phone
OR
GET YOUR SAVINGS CARD THROUGH TEXT MESSAGE
You can also get your savings card by texting FREE to 99789† for a coupon code sent directly to your phone.
Text STOP to opt out. Text HELP for help. Up to 10 messages per month. You will only be contacted in regard to BEVESPI AEROSPHERE Patient Support, your privacy will be protected, and your information will not be shared. For more information, visit www.azprivacynotice.com
†By texting the number from your mobile number, you agree to receive BEVESPI AEROSPHERE text messages generated by an automated dialer to this number. You understand that consent is not required to make a purchase and agree that your text is your electronic signature and provides electronic written consent. Message and data rates may apply.
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WAIT…THERE’S MORE!
For care beyond your prescription.
Breathing Room was created to help give you room to breathe.
Step inside to your breathing destination, and let us connect you to the services and support that can help with your treatment and beyond. Open up possibilities, connect with others, and let us help you focus on what really matters—your breathing.
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, subject to label indication. [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/covered patients with no restrictions (step-edit, prior authorization, or NDC block) and with a valid prescription for BEVESPI AEROSPHERE® (glycopyrrolate 9 mcg/formoterol fumarate 4.8 mcg) who present this savings card at participating pharmacies will receive 100% off their out-of-pocket costs for each covered [30-, 60-, or 90-day supply (1-3 inhaler(s), respectively)]. If you pay cash for your prescription, or are insured and your insurance does not cover or has a managed care restriction on your prescription (step-edit, prior authorization, or NDC block), you will receive up to [$100] in savings on your out-of-pocket costs for each inhaler. 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 12/31/18]. If you have any questions regarding this offer, please call [1-844-327-3401][1-844-327-3401].
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 at the time of purchase.
If your commercial insurance plan does not cover BEVESPI AEROSPHERE, use of this offer permits your health care 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
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 CHANGE HEALTHCARE 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-, 60-, or 90-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 CHANGE HEALTHCARE as a Secondary Payer COB with patient responsibility amount and a valid Other Coverage Code of 3. This will reduce eligible patient’s out-of-pocket costs by [$100] per 30-day supply. Reimbursement will be received from CHANGE HEALTHCARE.
Pharmacist Instructions for a Cash-Paying Patient: Submit this claim to CHANGE HEALTHCARE. 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 CHANGE HEALTHCARE. Valid Other Coverage Code Required. For any questions regarding CHANGE HEALTHCARE online processing, please call the Help Desk at [1-800-422-5604][1-800-422-5604].
Program managed by ConnectiveRx, 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 USE
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 may report side effects related to AstraZeneca products by clicking here.
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.