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How to redeem the patient access card:

1. Download and print your savings card by clicking on the button below:
2. When you fill your Rx, show this savings card to the pharmacist and receive your instant discount.
Ask the pharmacist to process your insurance first and this rebate second.

3. Keep this savings card with you for future refills. The card is valid for 12 uses.


All eligible patients receive savings. Please see eligibility terms below.
  • This offer is not valid for any person eligible for reimbursement of prescriptions, in whole or in part, by any federal, state, or other governmental programs, including, but not limited to, Medicare (including Medicare Advantage and Part A, B, and D plans), Medicaid, TRICARE, Veterans Administration or Department of Defense health coverage, CHAMPUS, the Puerto Rico Government Health Insurance Plan, or any other federal or state health care programs. This offer is not valid in Massachusetts or Minnesota or where otherwise prohibited, taxed or otherwise restricted.

  • Offer good only in the USA at participating retail pharmacies and cannot be redeemed at government-subsidized clinics.

  • This coupon may be used up to 12 times.

  • EPI Health reserves the right to rescind, revoke or amend this offer without notice.

  • The selling, purchasing, trading or counterfeiting of this coupon is prohibited by law.

  • Offer may not be combined with any other rebate, coupon, free trial, or similar offer. Coupon has no cash value. No cash back.

  • Patients understand and agree to comply with the terms and conditions of this offer as set forth here.


TO THE PHARMACIST:


EPI Health takes active measures to ensure pharmacies utilize this program in an authorized manner. By using this card, you certify you have read, understood and comply with the terms, conditions and RESTRICTIONS below. SimpleSave Rx has been authorized to reimburse you up to a maximum benefit, for processing this coupon when accompanied by a prescription for branded Minolira, BensalHP, Sitavig, Nuvail, Bionect or Cloderm. This coupon may be used up to 12 times for each individual patient. Non-insurance, copay cash discount cards may not be used with this offer.



FOR INSURED PATIENTS:


This card will cover the difference between the patient’s co-pay and up to the program maximum, which is subject to change. Any additional amounts due are the responsibility of the patient.



This claim may be submitted in one of the following three ways:


1. This claim may be submitted electronically through SimpleSave Rx. Submit all claims in NCPDP standard D.O. Secondary processing should follow NCPDP standards for Co-pay Only billing using group code X10200 and Other Coverage Code 8 (OCC8), if the patient’s primary insurance does not cover the brand please resubmit using group code X10210 and Other Coverage Code 3 (OCC3). If you have any questions regarding electronic submission, please call the pharmacy processing help desk at 1-844-728-3479 (844-SAVE4RX).


OR



2. If you are unable to transmit this claim electronically, please process under your standard format for a “paper claim” submission. Paper claims are to be submitted to: SimpleSave Rx 3350 N Arizona Ave., Suite 2, Chandler, AZ 85225.


OR


3. If you are unable to process this claim electronically or through your standard “paper claim” format, please return the voucher to the patient and instruct the patient to mail this voucher, along with a duplicate pharmacy label or pharmacy receipt which must include the following information: drug name, the drug quantity, the prescription number, the fill date, the name and address of the pharmacy, the prescribing physician, the patient’s name, and the co-pay amount paid. In addition to this information, please instruct the patient to include the patient’s return address and to mail this information to SimpleSave Rx, 3350 N Arizona Ave., Suite 2, Chandler, AZ 85225, for prompt payment. For expedited processing, fax voucher and Rx receipt to: 480-444-1449. Please retain a copy of the coupon and file with each prescription for auditing purposes and return the original to the patient.



RESTRICTIONS:


Offer good only in the USA at participating retail pharmacies and cannot be redeemed at government subsidized clinics. Non-insurance, copay cash discount cards are prohibited for use in conjunction with this program. This offer is not valid for any person eligible for reimbursement of prescriptions, in whole or in part, by any federal, state, or other governmental programs, including, but not limited to, Medicare (including Medicare Advantage and Part A, B, and D plans), Medicaid, TRICARE, Veterans Administration or Department of Defense health coverage, CHAMPUS, the Puerto Rico Government Health Insurance Plan, or any other federal or state health care programs. If the patient is eligible for benefits under any such program, the patient cannot use this offer. This offer is not valid in the State of California or by any resident of the State of California with regard to any product for which a therapeutically equivalent generic product is available, including Cloderm. This offer also is not valid in Massachusetts or Minnesota or where otherwise prohibited, taxed or otherwise restricted. The selling, purchasing, trading or counterfeiting of this coupon is prohibited by law. Offer may not be combined with any other rebate, coupon, free trial, or similar offer. This coupon is not transferable and has no cash value. EPI Health LLC reserves the right to rescind, revoke or amend this offer without notice.

MINOLIRA is indicated to treat only the pimples and red bumps (inflammatory lesions of non-nodular acne) of moderate to severe acne in patients 12 years of age and older.

MINOLIRA is not effective on acne that does not look red or swollen (non-inflammatory acne). The safety of MINOLIRA is not known after using it for 12 weeks. MINOLIRA has not been tested for the treatment of infections.
  • Do not use MINOLIRA if you are allergic to any of the tetracycline class of drugs. Ask your doctor or pharmacist for a list of these drugs if you are not sure. Stop taking MINOLIRA right away if a rash or other allergic symptoms appear.
  • Do not use MINOLIRA if you are pregnant, may become pregnant or are nursing. If you become pregnant while taking MINOLIRA, stop taking it and call your doctor. Taking MINOLIRA during pregnancy, infancy and/or childhood up to the age of 8 years may permanently discolor teeth (yellow-gray-brown) and slow the growth of bones.
  • Severe irritation and bleeding in the colon (called pseudomembranous colitis) can happen while taking most antibiotics and can range from mild to life-threatening. Talk to your doctor if you have watery diarrhea, diarrhea that doesn’t go away or bloody stools.
  • Before taking MINOLIRA, tell your doctor if you have kidney or liver problems.
  • Protect your skin from the sun while taking MINOLIRA. Avoid sunlight, sunlamps, and tanning beds as you are more likely to get a severe sunburn. Avoid driving or operating dangerous machinery until you know whether MINOLIRA causes you to feel dizzy or light-headed, or a spinning feeling (vertigo).
  • Minocycline may cause severe headaches and autoimmune disorders. Stop taking MINOLIRA if symptoms occur.
  • The most commonly observed side effects are headache, tiredness, dizziness and itching.


To report SUSPECTED ADVERSE REACTIONS contact EPI Health, LLC at 800-499-4468
or FDA at 1-800-FDA-1088 or visit www.fda.gov/medwatch.