Give your patients with ACS important information about BRILINTA



APPROVED USE
BRILINTA is a prescription medicine for adults used to:
- decrease your risk of death, heart attack, and stroke in people with a blockage of blood flow to the heart [acute coronary syndrome or ACS] or a history of a heart attack. BRILINTA can also decrease your risk of blood clots in your stent in people who have received stents for the treatment of ACS.
Please read accompanying Medication Guide and full Prescribing Information, including Boxed WARNINGS, for BRILINTA 60-mg and 90-mg tablets. Please read Important Safety Information throughout.
BRILINTA Patient Brochure
This valuable educational brochure explains:
- What BRILINTA is and how to take it
- How BRILINTA works
- Why the patient is at risk for another event
- A Savings Card* and details about the offer
Order copies of the patient brochure, speak to a live representative at 1-888-512-7454, 7 AM to 9 PM ET, 365 days a year.
*Subject to eligibility rules; restrictions apply.
Let patients know there is more information for them available on brilinta.com

Help patients understand how to take BRILINTA and track it every day with a Medicine Planner

Let patients know there is more information for them available on brilinta.com
Encourage patients with ACS to sign up for survivor support
Help your patients with ACS prepare for their next visit with this question guide
Want to help your patients get started on BRILINTA?
EXPLORE MORE
Full Language for Commercially Insured and Cash-Paying Patients
ELIGIBILITY: You may be eligible for this offer if you are insured by commercial insurance and your insurance does not cover the full cost of your prescription, or you are not insured and are responsible for the cost of your prescriptions. Patients who are enrolled in a state- or federally funded prescription insurance program are not eligible for this offer. This includes patients enrolled in Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DOD) programs or TriCare, and patients who are Medicare-eligible and enrolled in an employer-sponsored group waiver health plan or government-subsidized prescription drug benefit program for retirees. If you are enrolled in a state- or federally funded prescription insurance program, you may not use this Savings Card even if you elect to be processed as an uninsured (cash-paying) patient. This offer is not insurance and is restricted to residents of the United States and Puerto Rico.
TERMS OF USE: Eligible commercially insured/covered patients with no restrictions (step-edit, prior authorization, or NDC block) and a valid prescription for BRILINTA® (ticagrelor) tablets who present this Savings Card at participating pharmacies will pay as low as $5 per 30-day supply. A $200 maximum savings limit applies; patient’s out-of-pocket expense may vary. If you are insured and your insurance does not cover or has a managed-care restriction on your prescription (step-edit, prior authorization, or NDC block), you will pay as low as $5 per 30-day supply. If you pay cash for your prescription, AstraZeneca will pay up to the first $100 per month, and you will be responsible for any remaining balance, for each monthly prescription. Other restrictions may apply. Patient is responsible for applicable taxes, if any. Nontransferable, limited to one per person, cannot be combined with any other offer. Void where prohibited by law, taxed, or restricted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer. AstraZeneca reserves the right to rescind, revoke, or amend this offer, eligibility, and terms of use at any time without notice. This offer is not conditioned on any past, present, or future purchase, including refills. Offer must be presented along with a valid prescription at the time of purchase. For additional details about this offer, please visit www.brilinta.com. If you have any questions regarding this offer, please call 1-833-274-5468.
BY USING THIS CARD, YOU AND YOUR PHARMACIST UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.
Pharmacist Instructions for a Patient With an Eligible Third-Party Payer:
For Commercially Insured/Covered Patients: Submit the claim to the primary Third-Party Payer first, then submit the balance due to Change Healthcare as a Secondary Payer COB with patient responsibility amount and a valid Other Coverage Code of 8. This will reduce the eligible patient’s out-of-pocket costs to as low as $5 for each 30-day supply, subject to a maximum savings limit of $200 for the program; patient’s out-of-pocket expenses may vary. Reimbursement will be received from Change Healthcare.
Pharmacist Instructions for Insured/Not Covered Patients: Submit the claim to the primary Third-Party Payer first; if the primary claim submission shows a managed-care restriction (step-edit, prior authorization, or NDC block), continue the claim adjudication process and submit the balance due to Change Healthcare as a Secondary Payer COB with patient responsibility amount and a valid Other Coverage Code of 3. This will reduce eligible patient’s out-of-pocket costs to as low as $5 for each 30-day supply, subject to a maximum savings limit for the program; patient’s out-of-pocket expenses may vary. Reimbursement will be received from Change Healthcare.
Pharmacist Instructions for a Cash-Paying Patient: Submit this claim to Change Healthcare. A valid Other Coverage Code (eg, 1) is required. The card may cover up to a maximum of $100 per each 30-day supply. Reimbursement will be received from Change Healthcare. For any questions regarding Change Healthcare online processing, please call the Help Desk at 1-800-422-5604.
Program managed by ConnectiveRx on behalf of AstraZeneca. 