This coupon is not insurance
Processing information:
RxBIN: 610524 RxPCN: Loyalty RxGRP: 40006462 ISSUER: (80840) ID: 160689749
Patient:

You must present this card to the pharmacist along with your prescription to participate in this program. If you have any questions regarding your eligibility or benefits, or if you wish to discontinue your participation, call the Semprex®‑D program at 1‑800‑657‑7613 (8:00 AM‑8:00 PM ET, Monday‑Friday). This offer is not valid where void or prohibited by law. Auxilium reserves the right to rescind, revoke or amend this offer at any time. Patients must be 18 years or older to participate. This offer is not transferable and cannot be sold. You are not eligible for this program if prescriptions are paid by any state or other federally funded programs, including, but not limited to Medicare or Medicaid, Medigap, VA or DOD or Tricare, or where prohibited by law; and you will otherwise comply with the terms above.

Pharmacist:

When you use this card, you are certifying that you have not submitted and will not submit a claim for reimbursement under any federal, state or other governmental programs for this prescription.


*Subject to terms and eligibility listed on this coupon.

The full prescribing information for Semprex®-D is available by asking your doctor or pharmacist or by visiting www.SemprexD.com

Auxilium reserves the right to rescind, revoke or amend this offer at any time.