Eligibility

Before you request your card, you should know that in order to be eligible for this offer: (a) where third party reimbursement covers a portion of your prescription, this card is valid only for the amount of your actual out-of-pocket expense up to a maximum of $15, (b) your prescription MUST NOT be covered (for example, reimbursed) by a federal healthcare program, including Medicare or Medicaid, or by any similar federal or state program, including a state pharmaceutical assistance program, and (c) you MUST NOT be Medicare eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees (for example, you are eligible for Medicare Part D, but receive a prescription drug benefit through a former employer). Further, if you are a resident of Massachusetts, this offer is valid only if you are paying the entire cost of the prescription yourself (for example, your insurance does not cover any of the cost of your prescription). Your acceptance of this offer must be consistent with the terms of any private or public health program in which you are a participant. This offer may not be used with any other discount, coupon, or offer, and this card is not valid if reproduced. This offer is good only in the USA, is not transferable, and is void where prohibited by law, taxed, or restricted. GlaxoSmithKline reserves the right to rescind, revoke, or amend this program or this card without notice.