Eligible patients, in consultation with their doctor, may receive up to 3 free trials of 10 tablets each, 1 trial of each strength of BELSOMRA. The free trial is not valid for 5‑mg strength and the voucher is not insurance.
If your doctor prescribed BELSOMRA, and you are eligible, follow these simple steps to receive a free 10‑tablet trial supply of BELSOMRA:
STEP 1: Review and accept the Terms and Conditions of the voucher:
- The voucher is valid for 1 free 10‑tablet trial supply of BELSOMRA per valid strength.
- The voucher is not valid for the 5‑mg strength of BELSOMRA.
- Limit 1 voucher per patient per valid strength. Patients who have previously redeemed a voucher for any strength of BELSOMRA are not eligible to redeem the voucher for that strength.
- Free trial offer is valid only for up to a 10-tablet trial supply per valid strength of BELSOMRA. No purchase is necessary. Refills are not required.
- The voucher is not transferable. No substitutions are permitted. The offer cannot be combined with any other free trial, coupon, discount, prescription savings card, or other offer.
- The voucher is not insurance.
- Subject to changes in state law, the voucher may become invalid for residents of Massachusetts prior to its expiration date.
- You must be 18 years of age or older to redeem the voucher. Patient, pharmacist, and prescriber agree not to seek reimbursement for all or any part of the benefit received by the recipient through the offer. The free trial supply cannot be used toward any out‑of‑pocket costs under any plan (such as true out-of-pocket expense [TrOOP]).
- The voucher can be used only by eligible residents of the United States or the Commonwealth of Puerto Rico at participating eligible retail pharmacies in the United States or the Commonwealth of Puerto Rico. Product must originate in the United States or the Commonwealth of Puerto Rico.
- The voucher is the property of Merck and must be turned in on request.
- It is illegal to sell, purchase, trade, or counterfeit or offer to sell, purchase, trade, or counterfeit the voucher. Void if reproduced. Void where prohibited by law, taxed, or restricted.
- Merck reserves the right to rescind, revoke, or amend the offer at any time without notice.
- Data related to your redemption of the voucher may be collected, analyzed, and shared with Merck, for market research and other purposes related to assessing voucher programs. Data shared with Merck will be aggregated and de-identified, meaning it will be combined with data related to other voucher redemptions and will not identify you.
- Expiration Date: 10/31/2025.
STEP 2: Click the button below and Print or Save the voucher.
STEP 3: The voucher will be ready to use at an eligible retail pharmacy (certain restrictions apply).
You must confirm that you have read and agree to the Terms and Conditions of the voucher.