Rebate

Patient Access Card

Download and print your savings card by clicking on the button below:

Download Card

How to Redeem:

1. When you fill your Rx, show this savings card to the pharmacist and receive your discount. The pharmacist should process your insurance first, which may require a prior authorization, and this rebate second.

2. Keep this savings card with you for future refills. The card is valid for 13 uses.

*All eligible patients receive savings.

Eligibility Terms

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. Your offer has its own unique ID number. This offer is not transferable, is limited to one per person and may not be combined with any other offer.

This claim may be submitted in the following way:

This claim may be submitted electronically through PDMI. Submit all claims in NCPDP standard D.O. Secondary processing should follow NCPDP standards for Co-pay Only billing using group code 99994035 and Other Coverage Code 8 (OCC8), if the patient’s primary insurance does not cover the brand please resubmit using group code 99994035 and Other Coverage Code 3 (OCC3). If you have any questions regarding electronic submission, please call the pharmacy processing help desk at 1-877-492-6961.

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.