See below for more program details.
*For qualifying patients only. Restrictions apply. See program rules and eligibility requirements for more information. Maximum reduction of up to $100 per prescription (minimum of 18 tablets).
Redeem this card ONLY when accompanied by a valid prescription for LYSTEDA (minimum of 18 tablets). Prescriber ID# required on prescription. This card is valid toward out-of-pocket expenses for LYSTEDA.
Patient Instruction: Use this card to reduce your out-of-pocket expense up to $100 (after you pay the first $30) on an eligible third party or cash paying prescription by presenting it to your pharmacist along with your valid prescription for LYSTEDA (minimum of 18 tablets). If your co-pay is $30.00 or less then no discount is applied. If your total out of pocket expense exceeds $130, then you are responsible for the additional balance. Keep this card and present it with each prescription for up to a maximum of 6 prescriptions through the expiration date of December 31, 2012.
Pharmacist for Patients Paying Cash: Submit this claim to Therapy First Plus for reimbursement. A valid other coverage code is required, (e.g. 1). The patient is responsible for the first $30.00 and up to a $100 maximum reimbursement will be received from Therapy First Plus. (minimum of 18 tablets). If patient pay amount is $30.00 or less then no discount is applied. If patient's total out of pocket expense exceeds $130, the patient is responsible for the additional balance. This card can be used with each prescription for up to a maximum of 6 prescriptions through the expiration date of December 31, 2012.
Pharmacist for Patients with an Authorized Third Party: Submit this claim to the Primary Third Party Payer first, then submit the balance due to Therapy First Plus as a secondary payer as a copay only billing using a Valid Other Coverage Code (e.g.8). The patient is responsible for the first $30.00 and up to a $100 maximum reimbursement will be received from Therapy First Plus. (minimum of 18 tablets). If patient co-pay is $30.00 or less then no discount is applied. If patient's total out of pocket expense exceeds $130, the patient is responsible for the additional balance. This card can be used with each prescription for up to a maximum of 6 prescriptions through the expiration date of December 31, 2012.
Pharmacist only: For any questions regarding Therapy First Plus online processing, please call the Help Desk at 1-800-422-5604
Terms and Conditions: This LYSTEDA® Savings Card is not valid for prescriptions reimbursed in whole or in part by Medicaid, Medicare, federal, or state programs (including any state prescription drug programs). This LYSTEDA® Savings Card is good for use only with a prescription for LYSTEDA® at the time the prescription is filled and dispensed. Offer good only in the USA at participating retail pharmacies and cannot be redeemed at government-subsidized clinics. This offer is not valid where prohibited by law. By choosing to process a claim to a third-party payer in connection with this offer, the retail pharmacy hereby represents, warrants, and acknowledges to Ferring that Ferring is not interfering with any legal obligation that the retail pharmacy may have to any third party and that processing the claim is not otherwise in violation of applicable law. Ferring Pharmaceuticals reserves the right to rescind, revoke, or amend this offer without notice. The selling, purchasing, trading, or counterfeiting of this card is prohibited by law. Participating patients and pharmacists understand and agree to comply with the terms and conditions of this offer as set forth above.
This offer expires December 31, 2012
Limit one LYSTEDA Savings Card per patient.
©2012 Ferring Pharmaceuticals Inc. 8/12
It’s a conversation worth having
with your doctor
Only your doctor can help you make this decision, so make an
appointment this month and share your answers.
||Do you soak through one or more pads or tampons every hour for several hours?
||Do you need to change your sanitary protection during the night?
||Do you need to double-up sanitary protection?
||Do you have to plan around your heavy period?
||Do you limit your daily activities?
||Do you cancel plans, miss school, work, or family events?
LYSTEDA® (tranexamic acid) tablets is a prescription medicine used to treat your heavy monthly period (menstruation) when your bleeding gets in the way of social, leisure and physical activities. LYSTEDA does not contain any hormones and is taken only during your period. It does not treat premenstrual symptoms, does not affect your fertility, and cannot be used as birth control. It does not protect against sexually transmitted diseases. LYSTEDA has not been studied in adolescents younger than 18 years of age.
IMPORTANT SAFETY INFORMATION
Do not take LYSTEDA if:
- You currently are using a form of birth control that contains estrogen and a progestin (like birth control patch or vaginal ring). Ask your healthcare provider before taking LYSTEDA if you are not sure if your birth control method contains estrogen or progestin;
- You have or have ever had a blood clot, have been told you are at risk for having a blood clot; or
- You are allergic to LYSTEDA or tranexamic acid.
LYSTEDA can cause serious side effects, including:
- The risk of serious blood clots may be increased when LYSTEDA is taken with medicines used to help your blood clot or some medicines used to treat leukemia.
- Stop taking LYSTEDA and promptly report any eye problems to your healthcare provider.
- If you have shortness of breath and your throat feels tight, stop taking LYSTEDA and get medical help right away.
Before taking LYSTEDA, tell your healthcare provider about all of your medical conditions, including whether: you have ever had a blood clot or been told that you are at risk of having a blood clot, you are using a form of birth control that contains hormones, you are pregnant or think you may be pregnant, you are breastfeeding or plan to breast-feed, the time between the start of your periods is less than 21 days or more than 35 days, or you have any other medical conditions.
Tell your healthcare provider about all the medicines you take, especially if you take: birth control pills or other hormonal birth control, medicines used to help your blood clot, medicines used to break up blood clots, or any medicines to treat leukemia.
The most common side effects of LYSTEDA include: headaches, sinus and nasal problems, back pain, pain in your abdomen, pain in your muscles or joints, anemia, and fatigue.
If you notice a change in your usual bleeding pattern that worries you, or your heavy bleeding continues, contact your healthcare provider right away. This may be a sign of a more serious condition.
You are encouraged to report side effects of prescription drugs. Contact Ferring at 1-888-FERRING (1-888-337-7464) or call 1-800-FDA-1088 or visit www.fda.gov/medwatch.
Please see Full Prescribing Information.
©2012 Ferring Pharmaceuticals Inc. 8/12