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Esbriet® Copay Program

Terms and Conditions

By using this coupon, you and your pharmacist understand and agree to comply with these terms and conditions.

Coupon not valid for prescriptions reimbursed in whole or in part under Medicaid, Medicare (including Medicare Advantage and Part D prescription drug plans), or any other federal or state program (including state pharmaceutical assistance programs) or where prohibited, taxed, or otherwise restricted. This coupon is not insurance. Offer may not be combined with any other rebate, coupon, free trial or similar offer. Coupon has no cash value. No cash back.

It is a violation of Federal law for a Pharmacy, Physician, or employee of Legacy Pharma to knowingly violate this program’s business rules and may instigate an immediate claims reversal. The selling, purchasing, trading or counterfeiting of this coupon is prohibited by law. Offer good only in the USA at participating retail pharmacies and cannot be redeemed at government-subsidized clinics. This coupon may be used for each new or refill prescription. Legacy Pharma reserves the right to rescind, revoke, or amend this offer without notice.