Use this coupon to get up to $10 off*

a one-month prescription of ADVAIR

ADVAIR

Patients:Please print this page from the Web site and present it with your prescription to your pharmacist to receive up to $10 off your next refill of ADVAIR.

BIN# 610524
Group# 50775424
Cardholder ID# 834918025
Claims Processor: McKesson
Corporation
RxPCN - Loyalty
Expiration Date: Sun Feb 19, 2012

ADVAIR DISKUS 250/50 is approved for adults with COPD, including chronic bronchitis, emphysema, or both. ADVAIR DISKUS is not for, and should not be used to treat, sudden, severe symptoms of COPD. ADVAIR won’t replace a rescue inhaler. You should only take 1 inhalation of ADVAIR twice a day. Higher doses will not provide additional benefits.

Please see complete Prescribing Information and Medication Guide for ADVAIR DISKUS available at
http://us.gsk.com/products/assets/us_advair.pdf.

*Subject to eligibility. Restrictions apply. See below for details.

Limit one per purchase. Cannot be combined with any other offer.

  • Present this coupon to your pharmacist with your prescription or when requesting your refill for ADVAIR DISKUS to receive up to $10 off your prescription of ADVAIR.
  • Not valid with any other offer.
  • Each coupon may be used only one time. You may use it either for a prescription or a refill of your prescription.
  • To aid in processing, please present this coupon when you DROP OFF your prescription or request your refill, NOT when you pick up.

Important Safety Information About ADVAIR DISKUS 250/50 for COPD

  • Do not use ADVAIR to treat sudden, severe symptoms of COPD. Always have a rescue inhaler medicine with you to treat sudden symptoms.
  • Do not use ADVAIR DISKUS if you have severe allergy to milk proteins. Ask your doctor if you are not sure.
  • Do not use ADVAIR more often than prescribed. Do not take ADVAIR with other medicines that contain long-acting beta2-agonists for any reason. Tell your doctor about medicines you take and about all of your medical conditions.
  • ADVAIR DISKUS can cause serious side effects, including:
    • serious allergic reactions. Call your healthcare provider or get emergency medical care if you get any of the following symptoms of a serious allergic reaction:
      • rash
      • hives
      • swelling of the face, mouth, and tongue
      • breathing problems
    • sudden breathing problems immediately after inhaling your medicine
    • effects on heart
      • increased blood pressure
      • a fast and irregular heartbeat
      • chest pain
    • effects on nervous system
      • tremor
      • nervousness
    • reduced adrenal function (may result in loss of energy)
    • changes in blood (sugar, potassium, certain types of white blood cells)
    • weakened immune system and a higher chance of infections. You should avoid exposure to chickenpox and measles, and, if exposed, consult your healthcare provider without delay. Worsening of existing tuberculosis, fungal, bacterial, viral, or parasitic infections, or ocular herpes simplex may occur.
    • lower bone mineral density. This may be a problem for people who already have a higher chance of low bone density (osteoporosis).
    • eye problems including glaucoma and cataracts. You should have regular eye exams while using ADVAIR DISKUS.
    • pneumonia. People with COPD have a higher chance of getting pneumonia. ADVAIR may increase the chance of getting pneumonia. Call your doctor if you notice any of the following symptoms:
      • increase in mucus (sputum) production
      • change in mucus color
      • fever
      • chills
      • increased cough
      • increased breathing problems
  • Common side effects of ADVAIR DISKUS 250/50 for COPD include thrush in the mouth and throat, throat irritation, hoarseness and voice changes, viral respiratory infections, headache, and muscle and bone pain.

TO THE PATIENT:
Where third-party reimbursement covers a portion of your prescription, this coupon is valid only for the amount of your actual out-of-pocket expenses up to a maximum of $10. Not valid for patients under Medicaid, Medicare, or similar state or federal programs. Not valid for residents of Massachusetts unless paying the full cost of the prescription. Your acceptance of this offer must be consistent with the terms of any drug benefit provided by your health insurer, health plan, or private third-party payer, and you agree to report acceptance of this offer to your health insurer, health plan, or third-party payer as may be required. This offer may not be used with any other discount, coupon, or offer. This program does not support mail-order pharmacy processing. This coupon is the property of GlaxoSmithKline and must be returned upon request. Only an original coupon will be accepted and must be presented to your pharmacist at the time you have the prescription filled—not valid if reproduced. Offer good only in USA. Not valid for residents of Puerto Rico. Not transferable. Void where prohibited by law, taxed, or restricted. Limit 1 per purchase. GlaxoSmithKline reserves the right to rescind, revoke, or amend this coupon without notice.

By tendering this coupon, I, the Patient, certify that: (i) I have read the above terms, (ii) I will not submit a claim for reimbursement under any federal, state, or other governmental programs for this prescription, (iii) if I am Medicare eligible, I am not enrolled in an employer-sponsored health plan or prescription drug plan for retirees, and (iv) I will otherwise comply with the terms above.

TO THE PHARMACIST:
McKesson Corporation has been authorized to reimburse you up to $10 plus an administration fee for processing this coupon when accompanied by a valid prescription (or refill) for ADVAIR.

  • If primary coverage exists, input card information as secondary coverage and transmit using the COB segment of NCPDP transaction.
  • Applicable discounts will be displayed in the transaction response.
  • Please clear COB secondary screen after processing transaction.

By redeeming this coupon, I certify that: (i) I have received this coupon from an eligible patient, (ii) I have dispensed the product as indicated, (iii) I have not submitted, and will not submit, a claim for reimbursement to the patient or any federal, state, or other governmental payer, or to any Medicare Part D Plan, (iv) I have not retained or provided to any person or entity any portion of the amount being made available to the patient, and (v) I will otherwise comply with the terms hereof. I further certify that my participation in this program is consistent with all applicable state laws and any obligations, contractual or otherwise, that I have as a pharmacy provider.

GlaxoSmithKline reserves the right to discontinue this offer at any time. It is a violation of federal law to buy, sell, or counterfeit this coupon.

For pharmacy processing questions, please call the Help Desk at 1-800-657-7613.
Hours of operation Monday-Friday, 8AM-9PM ET. Saturday 9:30AM-6PM ET, excluding holidays.

You are encouraged to report negative side effects of prescription drugs to the FDA.
Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

©2010 The GlaxoSmithKline Group of Companies All rights reserved.