- By using this coupon, you
acknowledge that you meet the eligibility criteria and will comply
with the terms and conditions.
- Present this coupon to your pharmacy along with a valid prescription for XOFLUZA and
- You will pay the first $30
- Genentech will pay up to the next $60 depending on your
Any additional amounts due are your responsibility.
If you have any questions, call 1-855-XOFLUZA.
- The processing
information on this card can be repeatedly used for all your
- When you apply this offer, you are
certifying that the patient meets the eligibility criteria, that you
have not submitted and will not submit a claim for reimbursement
under any state- or federally funded prescription insurance program
for this prescription.
- For commercially insured
patients, process a coordination of benefits (COB) transaction using
the patient’s prescription insurance for the primary claim. Submit a
secondary claim to Argus using BIN:600428/PCN:06780000. For
uninsured or cash-paying patients, submit a PRIMARY claim to Argus
using BIN:600428/PCN:06780000. For help processing the coupon please
*Patient Eligibility/Terms and Conditions:
- This offer is valid for
eligible patients receiving prescription XOFLUZA. It may be used by
those with or without commercial insurance, including patients who
choose to pay cash. This offer may not be used for any other
This offer may not be used by patients in conjunction with
prescription insurance under Medicaid, Medicare, TRICARE or
similar federal or state programs. This offer is not health
insurance or a benefit plan.
- Offer only valid in the United States and U.S.
Territories. This offer is not transferable and may not be combined
with any other offer.
- Offer must be presented along
with a valid prescription for XOFLUZA at the time of purchase.
- The patient or their guardian must be 18 years or older to
receive coupon benefits.
- May be used twice per season. Valid until July 31, 2019.
program is void where prohibited by law and on the date an AB rated
generic equivalent for XOFLUZA becomes available.
- Genentech USA, Inc. reserves the right to rescind, revoke, or amend this offer at any time without notice. It is a violation of federal law to buy, sell, or counterfeit this offer.