Rules & Eligibility

To be eligible for the Free Trial offer:

ELIGIBILITY REQUIREMENTS
TO THE PATIENT: You may use this Free Trial Offer only for free product. That is, in order to be eligible for this offer, this Free Trial Offer must be accompanied by a valid, signed prescription. Further, you are NOT eligible for this offer if either: (a) this prescription will be submitted for reimbursement under any federal healthcare program, including Medicaid, Medicare (Part D or otherwise), or any similar federal or state programs, including any state pharmaceutical assistance program, or under any private insurance, HMO, or other third-party payment arrangement, or (b) any part of this prescription will be submitted to count toward your out-of-pocket cost under your prescription drug plan, such as the “True Out-Of-Pocket (TrOOP)” expenses under Medicare Part D. Only an original Free Trial Offer will be accepted and must be presented to your pharmacist at the time you have your prescription filled—not valid if reproduced.

Offer good only in USA. Void where prohibited by law, taxed, or restricted. Not valid in Massachusetts if AB-rated generic drug is available for the product. No purchase required. May not be used with any other discount, Free Trial Offer, or offer. GlaxoSmithKline (GSK) and McKesson (on GSK's behalf) reserve the right to rescind, revoke, or amend this Free Trial Offer without notice.

By tendering this Free Trial Offer, I, the Patient, certify that: (i) I have read the above terms, (ii) I am not being reimbursed by, nor will I submit a claim for reimbursement by, nor will I seek to have any portion of this prescription counted toward my out-of-pocket cost (eg, TrOOP) under, any federal, state, or private programs for this prescription, and (iii) I will otherwise comply with the terms above.

This Free Trial Offer is the property of GlaxoSmithKline and must be returned upon request.

To be eligible for the coupon:

ELIGIBILITY REQUIREMENTS
TO THE PATIENT: This coupon can be used whether or not you have insurance for the amount of your out-of-pocket expense for this prescription, up to a maximum of $10. This coupon must be accompanied by a valid, signed prescription. You are NOT eligible to use this coupon if you are a government beneficiary. You are a government beneficiary if this prescription is covered by or will be submitted for reimbursement under any federal healthcare program, including Medicaid, Medicare (Part D or otherwise), or any similar federal or state programs, including any state pharmaceutical assistance program. Further, you MUST NOT be Medicare eligible and enrolled in an employer-sponsored health plan or employer-sponsored prescription drug benefit plan for retirees (ie, you are eligible for Medicare Part D but receive a prescription drug benefit through a former employer).

Not valid in Massachusetts if AB-rated generic drug is available for the product. Your acceptance of this offer must be consistent with terms of any drug benefit plan provided to you by your health insurer. You agree to report your use of this coupon to your health insurer if required. Only original accepted—not valid if reproduced. One per purchase. May not be used with any other discount or offer. Offer good only in USA. Void where prohibited by law, taxed, or restricted.

GlaxoSmithKline (GSK) and McKesson (on GSK's behalf) reserve the right to rescind, revoke, or amend this coupon without notice.

By redeeming this coupon, I, the Patient, certify that: (i) I have read and will comply with program rules and requirements, (ii) I have not submitted and will not submit a claim for reimbursement under any federal, state, or other governmental programs for this prescription, and (iii) if I am Medicare eligible, I am not enrolled in an employer-sponsored health plan for retirees or a Medicare Part D Plan.

This coupon is the property of GlaxoSmithKline and must be returned upon request.