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Esbriet® Copay Program

Welcome to this Esbriet Copay Program that was designed to help those in financial need get the Esbriet medication they need

Eligible patients who are commercially insured pay as little as $5 for drug co-pays

How it works

Simply present the coupon to your pharmacist along with your valid prescription and insurance card. You will be asked for your personal information as well as other relevant details during the processing of the coupon. This will only be required for the initial usage of the coupon card.

This coupon can be used by patients with commercial health insurance and a prescription drug plan.

With this coupon, you should pay as little as $5 for each prescription.

If you have any issues with printing the coupon, contact us at 1-855-518-7562.

To get your coupon, answer the question below and click the button. You will be able print the coupon or download it as a PDF or an image (PNG file format).

2 + 9 =
Please solve the math to continue.
This quick check helps keep the program fair for everyone.

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.