Patients

PROGRAM DETAILS:

The Galderma® CAREConnect Program (the “Program”) is brought to you by Galderma Laboratories, L.P. The Program is only available for commercially insured or uninsured patients. Patients who are enrolled in a government-run or government-sponsored healthcare plan with a pharmacy benefit are not eligible to use the Galderma CareConnect Patient Savings Card (this “Card”). This Card provides savings on out-of-pocket expenses for up to a 30-day supply of included Galderma products, as described below. If you have valid prescriptions for more than one Galderma product, the copay expense and savings apply to each product. You may use this Card once every 30 days, depending on when you last received a 30-day supply of each Galderma product. Use of this Card does not obligate you to use or to continue using any Galderma product. You may use this Card at any participating pharmacy located in the United States.

This Card may not be combined with any savings, discount, free trial, or other similar offer for the same prescription. This Card is not transferable and is void if reproduced. This Card is not health insurance. Limit one (1) Card per patient. This Card has no cash value and will not be accepted outside of participating pharmacies in the United States. Please visit Galderma’s website for our privacy practices.

Use of this Card is subject to applicable state and federal law, and is void where prohibited by law, rule or regulation. In the event a lower cost generic drug that the FDA had designated as a therapeutically equivalent product is available for one of the Galderma products covered by this Card, or if the active ingredient of a Galderma product is available at a lower cost without a prescription, this offer will become void in California with respect to the Galderma product.

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Terms and Conditions:

Patient Instructions:

You must present this card to the pharmacist along with your prescription each time you fill your prescription to participate in the Program. If you have any questions regarding your eligibility or benefits or if you wish to discontinue your participation, call the Galderma CAREConnect Program at (855) 280-0543 (8:00 AM-8:00 PM EST, Monday-Friday). When you use this Card, you are certifying that you understand the Program rules, regulations, and these terms and conditions which are set forth at set forth at www.galdermacc.com/sites/default/files/pdf/TermsConditions.pdf, and that you will comply with them. You are not eligible if you are enrolled in Medicare Part D, Medicaid, Medigap, VA, DoD, TriCare, or any other government-run or government sponsored health care program with a pharmacy benefit. No purchase is necessary and there are no membership fees. You may not use this Card if prohibited by your insurer. You are responsible for any reporting for the use of this Card as required by your insurer.

By using this Card, you acknowledge that you currently meet the following eligibility criteria:

• You have a valid prescription for the Galderma product your copay and the savings apply to;
• You have no insurance or are subject to a private insurance copay requirement for your prescription;
• You are not enrolled in Medicare Part D, Medicaid, Medigap, VA, DoD, TriCare, or any other government-run or government sponsored health care program with a pharmacy benefit;
• You are at least 18 years old; and
• You reside in the United States.

Pharmacist Instructions:

When you accept/use this Card, you are certifying that you have not submitted and will not submit a claim for reimbursement under Medicare Part D, Medicaid, Medigap, VA, DoD, TriCare or any other government-run or government-sponsored health care program with a pharmacy benefit for this prescription and that you agree to to and understand the Program rules, regulations, and these terms and conditions which are set forth at www.galdermacc.com/sites/default/files/pdf/TermsConditions.pdf and that you will comply with them. By accepting/using this Card, you acknowledge and agree to/that:

• Submit transaction to McKesson Corporation using BIN #610524
• If primary commercial prescription insurance exists, input Card information as secondary coverage and transmit using the COB segment of the NCDPDP transaction. Applicable discounts will be displayed in the transaction response.
• Acceptance of this Card and your submission of claims for the Program are subject to the LoyaltyScript® program Terms and Conditions posted at www.mckesson.com/mprstnc.
• Patient is not eligible if prescriptions are paid in part or full by any state or federally funded programs, including but not limited to Medicare Part D, Medicaid, Medigap, VA, DoD, TriCare, or any other government-run or government–sponsored health care program with a pharmacy benefit or where prohibited by law.
• If you are filling a prescription in the state of California, in the event a lower generic drug that the FDA has designated as a therapeutically equivalent product becomes available for one of the Galderma products covered by this Card, or if the active ingredient of a Galderma product is available at a lower cost without a prescription, this offer is void with respect to that Galderma product and you agree not to apply this Card to any discount or savings to such patient under the Program for such Galderma product.
• For questions regarding setup, claims transmission, patient eligibility or other issues call LoyaltyScript® for Galderma CAREConnect Program at 855-280-0543 (8:00AM-8:00PM EST, Monday-Friday).

Galderma Laboratories, L.P. reserves the right to rescind, revoke, or amend this offer at any time.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.FDA.gov/MedWatch or Call 1-800-FDA-1088.

©2020 Galderma Laboratories L.P. United States, All Rights Reserved. All trademarks are the property of their respective owners. This site is intended for U.S. audiences only. Information in this website is not intended as medical advice. Talk with your doctor about medical concerns.
USMP/CAP/0024/1019(3)