Eligibility 8057

Please answer the highlighted question(s) in red.

* What type of insurance coverage do you have?

1 - Any government, state or federally funded prescription benefit program. This includes Medicare, Medicaid, Medigap, VA, DOD and Tricare?

2 - Commercial insured (private insurance)?

3 - Do not have prescription drug coverage - paying cash?

* I understand that the personal information I provide and information pertaining to my use of the coupon at the pharmacy will be shared with Prasco, LLC its third-party partners and McKesson entities.

Agree

Disagree

* I also authorize Prasco, LLC, its partners and McKesson entities to communicate with me about products, health conditions, co-pay and financial assistance. I agree to be contacted by mail, email, and at the phone number I provided to leave voice messages, and interactive voice recordings. I may opt out of individual communications of the program entirely at any time by calling (855) 733-4630, or by clicking on the "unsubscribe" link. Prasco, LLC and companies providing services to Prasco, LLC will not sell or rent my personally identifiable information, as described in the Privacy Policy, which I can view by visiting www.prasco.com.

Agree

Disagree

Pay as little as $10* for a 30-Day Supply

Please confirm that you are eligible:

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