Frequently Asked Questions about the Patient Savings Program for REQUIP

If you meet the eligibility requirements written on the back of your card, and once you have activated your card, you may receive an immediate savings up to $15 off your normal out-of-pocket expense for your prescription for REQUIP. This card can be used when filling each of your next 7 prescriptions for REQUIP Tablets (2-mg, 3-mg, 4-mg, or  5-mg strengths) for a maximum savings up to $105. Present the patient savings card to your pharmacist along with your valid prescription for 2-milligram, 3-milligram, 4-milligram, or 5-milligram strengths of REQUIP.

Can I use my patient savings card even though I have insurance?
Unless you live in Massachusetts, yes, you can use the patient savings card toward your co-pay up to $15. Patients in federal and state programs should see Patient Eligibility rules for more details.

Can I use the patient savings card if I’m enrolled in Medicaid or Medicare?
You can not use the patient savings card if your prescriptions are paid in part of full by any federal or state program, including Medicaid and Medicare. You cannot use the savings card if you are Medicare Part D eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees( i.e., you are eligible for Medicare Part D but receive a prescription drug benefit through a former employer). For more details, see the Patient Eligibility rules.

Can I use more than one patient savings card at a time?
No, you can only use one patient savings card at a time. This offer may not be used with any other discount, coupon, or offer, and this card is not valid if reproduced.

Can my patient savings card be used for any strength of REQUIP?
No, the patient savings card is only valid for REQUIP 2-milligram, 3-milligram, 4-milligram or 5-milligram Tablets.

Can I cash the patient savings card at my bank?
No, the patient savings card is only good toward the purchase of REQUIP at your pharmacy.

My pharmacist won’t accept the patient savings card. Why not and what can I do?
Unfortunately, not all pharmacies will accept the patient savings cards. You may want to check with another pharmacy.

My pharmacist is having trouble processing the patient savings card. What should he/she do?
Your pharmacist can call the pharmacy services helpdesk at 1-866-450-3277 for instructions on how to process the patient savings card.

I get my prescriptions filled through a mail-order pharmacy. Can I still use the patient savings card?
Yes, you can use the patient savings cards for mail-order prescriptions at participating mail-order pharmacies. You should present the patient savings cards at the time you order. We recommend that you contact the mail-order pharmacy ahead of time to confirm that your patient savings card will be accepted. If your mail-order pharmacy will not accept the patient savings card, please call the pharmacy services helpdesk at   1-866-450-3277 for further instructions.

I lost/tore my patient savings card. Can you replace it for me?
We are not able to replace the patient savings cards.

My patient savings card has expired. Can I get another one?
No, this is a one-time offer from REQUIP. There is a limit of one patient savings card per person. The offer is not transferable. The card expires one year after activation, or upon program termination by GlaxoSmithKline. GlaxoSmithKline reserves the right to rescind, revoke, or amend this program or this card without notice.

If I provide my name and address to activate my patient savings card, how will my information be used?
Please be assured that your personal information will be kept confidential according to our privacy policy. Refer to our privacy policy for additional information.

If I still have questions about the Patient Savings Program for REQUIP, what should I do?
You may contact the GlaxoSmithKline Response Center Monday through Friday, 8 a.m. to 8 p.m. ET, at 1-888-825-5249.