Copay Assistance Card for your
Sancuso prescriptions
Save up to $300 per patch on Sancuso
after paying the first $20 per prescription
(maximum $1200 per month for 4 or more patches)*
after paying the first $20 per prescription
(maximum $1200 per month for 4 or more patches)*
Just follow these easy steps:
- Show this Copay Assistance Card and your valid prescription each time you pay for your prescription.
- Pay the initial $20 of your copay for each prescription of Sancuso and any remaining out-of-pocket cost will be reduced by $300 for 1 patch to a maximum of $1200 per month for 4 or more patches.*
- Save your Copay Assistance Card – this card can be used multiple times up to 48 patches per patient. In no case, will the monthly benefit exceed $300 for 1 patch, $600 for 2 patches, $900 for 3 patches or $1200 for 4 or more patches.
Examples of what you might pay:
Number of Patches | Out-of-Pocket Cost | – | Copay Card Pays | = | You Pay |
1 | $250 | $230 | $20 | ||
2 | $500 | $480 | $20 | ||
3 | $900 | $880 | $20 | ||
4 | $1,300 | $1,200 | $100 |
*Offer expires 01/31/2019. For qualifying patients only. Restrictions apply.
Program rules and eligibility provided on copay card. This coupon is not insurance.
1-800-SANCUSO
www.sancuso.com
Sancuso is a registered trademark of Kyowa Kirin, Inc.
©2017 Kyowa Kirin, Inc. All rights reserved.
Printed in U.S.A. SAN-134-R3 September 2017