ABSORICA LD^™ Copay Card Program

To participate in the ABSORICA LD^™ (isotretinoin) capsules Copay Card Program ("Program"), you must present this card, along with a valid prescription for ABSORICA LD, to your pharmacist. Patients with commercial health insurance who qualify to participate may pay as little as $0 for 30 capsules of ABSORICA LD. Enrollment is subject to the Eligibility Rules and Terms and Conditions, stated below. If you have any questions regarding Eligibility, the Terms and Conditions, or to discontinue participation, please call 1-855-699-6815 (8:00 AM-8:00 PM EST, Monday-Friday).

Eligibility Rules

To participate in this Program, you must have commercial health insurance and be a resident of the United States, Puerto Rico, Guam, or the Virgin Islands
The following patients are ineligible for this Program.
- Patients covered under Medicaid (including Medicaid patients enrolled in a Medicaid Managed Care Plan or a qualified health plan purchased through a health insurance exchange marketplace established by a state government or the federal government)
- Patients covered by Medicare or a Medicare Part D or Medicare Advantage plan (regardless of whether a specific prescription is covered)
- Patients covered by TRICARE, CHAMPUS, Puerto Rico Government Health Insurance Plan or any other state or federal medical or pharmaceutical benefit program or pharmaceutical assistance program
- Patients who are members of health plans that claim to eliminate their out-of-pocket costs are not eligible for cost support. If you are a member of one of these plans, please call 1-877-264-2440
- Patients with no insurance

Terms and Conditions

You agree to not to seek any reimbursement for all or any part of the copay assistance received through the Program. By using this card, you are certifying that you understand the Eligibility Rules and Terms and Conditions, that you have responded truthfully to questions when activating the card, and that you will disclose and report your receipt of any Program benefits to your insurer, health plan, or any third party that pays or reimburses you for the cost of medications, if required
This offer may be rescinded, revoked, or cancelled at any time, without further notice, and the rules may be amended at any time, without further notice

Disclosures

This Program is not insurance
The Program is void where prohibited by law, taxed, or restricted. Any benefit provided is not transferable and cannot be combined with any other program, free trial, discount, prescription savings card, or other offer. No purchase, other than for an ABSORICA LD^™ prescription, is required to participate
Personal data that you provide to the Program may be collected, analyzed, and shared with the program sponsor for market research and other lawful purposes, but only in aggregated and de-identified form

ABSORICA LD can harm your unborn baby. Avoid ABSORICA LD if pregnant. ABSORICA LD can cause serious mental health problems including depression and psychosis. See additional safety information below.

ABSORICA LD is a prescription medication used in patients 12 years of age and older for the treatment of severe nodular acne that cannot be cleared up by any other acne treatments, including antibiotics.

Do not change between ABSORICA and ABSORICA LD or other isotretinoin products.

IMPORTANT SAFETY INFORMATION

What is the most important information I should know about ABSORICA LD?

ABSORICA LD can harm your unborn baby, including birth defects (deformed babies), loss of a baby before birth (miscarriage), death of the baby, and early (premature) births. Patients who are pregnant or who plan to become pregnant must not take ABSORICA LD.

Patients must not get pregnant:

for 1 month before starting ABSORICA LD
during treatment with ABSORICA LD
for 1 month after stopping ABSORICA LD

If you get pregnant during treatment with ABSORICA LD, stop taking it right away and call your healthcare provider.

Patients taking ABSORICA LD must register in the iPLEDGE^® Pregnancy Registry at 1-866-495-0654 or www.ipledgeprogram.com. See your healthcare provider for further information.

ABSORICA LD can cause serious mental health problems, including:

depression, psychosis (seeing or hearing things that are not real)
suicide. Some patients taking ABSORICA LD have had thoughts about hurting themselves or suicide. Consult your healthcare provider if you have such thoughts.

Stop taking ABSORICA LD and call your healthcare provider right away if you or a family member notices any signs or symptoms of depression or psychosis.

What are the possible side effects of ABSORICA LD?

ABSORICA LD can cause serious side effects, including:

increased pressure in the brain (intracranial hypertension). ABSORICA LD can increase the pressure in your brain. This can lead to permanent loss of eyesight, and in rare cases, death. Stop taking ABSORICA LD and call your healthcare provider right away if you get any of these signs of increased brain pressure:
- bad headache
- blurred vision
- dizziness
- nausea or vomiting
- seizures (convulsions)
- stroke
serious skin problems. Skin rash can occur in patients taking ABSORICA LD. Sometimes rash can be serious and may lead to death. Stop using ABSORICA LD and call your healthcare provider right away if you get:
- conjunctivitis (red or inflamed eyes, like "pink eye")
- rash with a fever
- blisters on legs, arms or face
- sores in your mouth, throat, nose or eyes
- peeling of your skin
inflammation of your pancreas (pancreatitis) can happen in patients who take ABSORICA LD and can lead to death. Call your healthcare provider right away if you have any of the following symptoms of pancreatitis:
- severe upper stomach (abdomen) pain
- swelling of your stomach
- nausea and vomiting
- fever
increased blood fat (lipid) levels. ABSORICA LD can raise blood fat levels (cholesterol and triglycerides). Your healthcare provider will do blood tests to check your lipids before and during treatment. These problems usually go away when ABSORICA LD treatment is finished.
hearing problems. Stop using ABSORICA LD and call your healthcare provider if your hearing gets worse or if you have ringing in your ears. Your hearing loss may be permanent.
liver problems, including hepatitis. Your healthcare provider will do tests to check your liver before and during treatment with ABSORICA LD.
inflammation of your digestive tract (inflammatory bowel disease). Stop taking ABSORICA LD and call your healthcare provider.
bone and muscle problems. Bone problems include bone pain, softening or thinning (which may lead to fractures). Tell your healthcare provider if you plan hard physical activity during treatment with ABSORICA LD.

Stop ABSORICA LD and call your healthcare provider right away if you have muscle weakness, which can be a sign of serious muscle damage.

ABSORICA LD may stop long bone growth in teenagers who are still growing.

vision problems. Stop taking ABSORICA LD and call your healthcare provider right away if you have any vision changes. ABSORICA LD may affect your ability to see in the dark. Some patients get dry eyes during treatment. If you wear contact lenses, you may have trouble wearing them during and after you stop treatment with ABSORICA LD.
serious allergic reactions. Stop taking ABSORICA LD and get emergency medical help right away if you get hives, a swollen face or mouth, or have trouble breathing. Stop taking ABSORICA LD and call your healthcare provider if you get a fever, rash, or red patches or bruises on your legs.
blood sugar problems, including diabetes. Tell your healthcare provider if you are very thirsty or urinate more than usual.

The most common side effects of ABSORICA LD include:

dry lips
dry skin
back pain
dry eyes
joint pain
nose bleeds
headache
upper respiratory tract infection (common cold)
chapped lips or swelling of the lips
skin reactions
muscle problems
eye problems, including decreased vision

These are not all of the possible side effects of ABSORICA LD. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or Sun Pharmaceutical Industries, Inc. at 1‑800‑818‑4555.

ABSORICA and ABSORICA LD are trademarks of Sun Pharmaceutical Industries, Inc.

All other trademarks are property of their respective owners.

ABSORICA LD™ Copay Card Program

Eligibility Rules

Terms and Conditions

Disclosures

ABSORICA LD^™ Copay Card Program