ANI Pharmaceuticals Derm Copay Savings Program

Patient Savings for OXISTAT® Lotion

The ANI Pharmaceuticals Derm Copay Savings Program can help eligible patients save on their OXISTAT® Lotion copays. Patients may pay as little as $25 for their prescription.*

The program requires patient enrollment.

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*Eligibility and restrictions: 1. Limitations apply. 2. Valid only for those with commercial insurance. 3. Not valid if prescriptions are paid in part or in full by any state or federally-funded healthcare program. 4. Not valid for cash-paying patients who have no commercial insurance or where plan reimburses you for the entire cost of your prescription drug. 5. Offer is not valid where prohibited by law. 6. Valid only for residents of the US. 7. This program is not health insurance. 8. Offer may not be combined with any other rebate, coupon, or offer. 9. This card is the property of ANI Pharmaceuticals, Inc. and must be returned upon request. 10. ANI Pharmaceuticals reserves the right to rescind, revoke, or amend the program without notice. 11. Patient certifies responsibility for complying with applicable limitations, if any, or any commercial insurance and reporting receipt of program rewards, if necessary, to any commercial insurer. 12. Acceptance of this card and your submission of claims for the ANI Pharmaceuticals Derm Copay Savings Program are subject to the Terms and Conditions established by McKesson Corporation, Inc. 13. This card has no cash value. For any questions regarding setup, claims transmission, patient eligibility or other issues, call the LoyaltyScript® Help Desk at 1-844-396-8097 (8:00 AM-8:00 PM EST, Monday-Friday).

Patient Instructions: Present this offer and your insurance card to your participating pharmacist along with an eligible prescription each time you fill your prescription. The prescriber ID# must be identified on the prescription. If you have any questions, please call 1-844-396-8097 (8:00 AM-8:00 PM EST, Monday-Friday). When you use this offer, you are certifying that you understand the program rules, regulations, and terms and conditions and that you will comply with them. You may not use this card if prohibited by your insurer.

Pharmacist Instructions: When you use this offer, you are certifying that you have not submitted and will not submit a claim reimbursement under any federal, state, or other government programs for this prescription. Pharmacist will comply with his/her obligations when processing the prescription for payment. By using this offer, you agree to the terms and conditions of this program. Co-pay cards must be accompanied by a valid prescription. If primary commercial prescription insurance exists, input offer information as secondary and transmit using the COB segment of the NCPDP transaction. Submit transaction to RxC Acquisition Company d/b/a RxCrossroads by McKesson using BIN 610524. Acceptable discounts will be displayed in the transaction response. Acceptance of this offer and your submission of claims are also subject to the Terms and Conditions posted at www.mckesson.com/mprstnc. If you have any questions, please contact the LoyaltyScript® Help Desk at 1-844-396-8097 (8:00 AM-8:00 PM EST, Monday-Friday).

ANI Pharmaceuticals, Inc. reserves the right to rescind, revoke, or amend this program without notice.