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To receive your rebate, ALL 4 requirements must be met.
Send:
1. The original Pharmacy
prescription receipt with purchase price circled
(no cash register receipt)
2. The
box bottom with UPC code from each box of Topicort Desoximetasone Cream USP, 0.25%
100g or 60g size purchased (Topicort brand only)
3.
This official mail-in certificate filled out completely
4. Mail to: Topicort 100 g or 60 g Rebate
P.O. Box 2227
Ocean, NJ 07712-2227
I have complied with all the terms of
this offer. By my signature, I certify that I am not being reimbursed
for this product
by Medicare or Medicaid, any other federal or state program, including any state
pharmaceutical assistance program. I further certify that I am not reimbursed for
this product by any other private third-party payers that reimburse me for the entire
cost of my prescription drugs.
I also understand that I am responsible for any reporting
or other requirements with respect to receipt of this rebate.
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Signature: ____________________________________________________________
(Must be signed in order to be valid)
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*Rebate amount limited to patients out-of-pocket
cost for Topicort (Desoximetasone) Cream USP,
0.25% 100 g or 60 g size only, up to $40.00.
Rebates are not valid for prescriptions reimbursed under a federally funded health
care program, including Medicare or Medicaid, as well as similar state programs,
including any state medical assistance programs. Rebates are also not valid for
private insurance plans that reimburse you for the entire cost of your prescription
drugs. This rebate is up to $40, or the amount of your co-pay, whichever is less.
Offer void where prohibited by law,
taxed or restricted. Offer good only in U.S.A.
Manufacturer reserves the right to rescind, revoke
or amend this offer without notice.
Allow 6-8 weeks for deliver.
Rebate offer valid
from 04/1/2009 to 12/31/2009.
Must be postmarked by 12/31/2009.
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Important Safety Information: |
The most common adverse reactions include burning, itching, irritation,
dryness, folliculitis, hypertrichosis,
acneiform eruptions, hypopigmentation, perioral
dermatitis, allergic contact dermatitis, maceration of the
skin, secondary infection,
skin atrophy, striae and miliaria. When used in large areas or under occlusive
dressing,
patients should be evaluated for HPA axis suppression. Before prescribing,
please
see
complete
Prescribing Information.
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