Nasacort ® AQ (triamcinolone acetonide) Mobile Program Processing Instructions and Frequently Asked Questions

To Pharmacist:

For Insured Customers:

Process as a copay-only billing claim using RxFastTrak as the secondary claim using BIN: 600428, PCN: 05080000, Group #: 05470008, and the customer’s 10-digit mobile phone number as their member ID. Use your customer’s prescription insurance for the primary claim. The secondary claim will pay up to $20 off your qualifying customer’s Nasacort AQ prescription. For processing questions, please call 1.877.my.Rx.save (1.877.697.9728).

For Cash-Paying Customers:

Submit claim for Nasacort AQ to RxFastTrak using BIN: 600428, PCN: 05080000, Group #: 05470008, and the customer’s 10-digit mobile phone number as their member ID. Your qualifying customer will receive up to $20 off their Nasacort AQ prescription.

Redeem one time when accompanied by a valid, signed prescription for Nasacort AQ with the appropriate dosage written on the prescription by the physician. This rebate does not apply if redeemed at a pharmacy in any state where it is prohibited by law. Not valid if reproduced or submitted to other payer. Prescriber ID# required on prescription. Valid for all strengths. No substitutions permitted. One rebate offer per patient. Cannot be combined with any other offers.

Pharmacy Frequently Asked Questions

Processing this offer

1. Who should I contact if I have a problem with processing this offer?

Contact the Nasacort AQ Mobile Program pharmacy helpline at 1.877.697.9728.

2. How I should process this claim?

For patients with insurance: Process as a copay-only billing claim using RxFastTrak as the secondary claim using BIN: 600428, PCN: 05080000, Group #: 05470008, and the customer’s 10-digit mobile phone number as their member ID. Use your customer’s prescription insurance for the primary claim. The secondary claim will pay up to $20 off your qualifying customer’s Nasacort AQ prescription.

For cash-paying customers: Submit claim for Nasacort AQ to RxFastTrak using BIN: 600428, PCN: 05080000, Group #: 05470008, and the customer’s 10-digit mobile phone number as their member ID. Your qualifying customer will receive up to $20 off their Nasacort AQ prescription.

3. Will this offer work with private insurance coverage? Are there any restrictions on this offer?

Yes, this offer will generally work with a patient’s private insurance. However, this offer is not valid for prescriptions reimbursed or paid under Medicare, Medicaid, or any government (public insurance) programs, or in the state of Massachusetts. Other restrictions may apply. Please refer to the Terms and Conditions of this offer for more information: www.121hm.com/NAQ/save/terms

4. If patients do not have health insurance, can they receive savings towards the out-of-pocket costs for Nasacort AQ?

Yes, patients can still receive savings towards their Nasacort AQ prescriptions. Qualifying prescription customers receive up to $20 off of their out-of-pocket expenses when purchasing Nasacort AQ. The savings apply to the first 5 prescriptions for a maximum rebate of $100. Limit of 5 rebates before December 31, 2010. Other terms and conditions may apply.

5. What are the restrictions of the program?

Duplicates of this offer are invalid and not redeemable.

Qualifying customers receive up to $20 off of their out-of-pocket expenses when purchasing Nasacort AQ. The savings apply to the first 5 prescriptions for a maximum rebate of $100. Limit of 5 rebates before December 31, 2010. Other terms and conditions may apply.

Offer not valid for prescriptions reimbursed or paid under Medicare, Medicaid, or any government (public insurance) programs, or in the state of Massachusetts. Other restrictions may apply. This offer may not be reproduced and must accompany your request. Offer good only for Nasacort AQ and only in the USA. Sanofi-aventis U.S. LLC reserves the right to rescind, revoke, or amend this offer without notice. Patients are responsible for reporting receipt of a rebate to any private insurer that pays for or reimburses you for any part of the prescription filled. One rebate offer per patient. Cannot be combined with any other offers.

Program enrollment

1. What can patients expect after they enroll in this program? How does this program work?

The program works via text messages sent to a patient’s mobile phone. If patients are eligible, they can redeem these messages for savings on their Nasacort AQ out-of-pocket expenses.* Patients will also receive text reminders when their next prescription is due, along with savings information. All they need to do is simply show you the offer codes text message when they pick up their Nasacort AQ prescription to redeem their savings. Please see “How should I process this claim?” above.

2. Will a patient’s personal information be shared with third parties?

Sanofi-aventis U.S. LLC respects a patient’s interest in keeping their personal information private. We will not sell or rent information to any third parties, outside mailing lists, or mobile marketers.

 Message and data rates may apply. Avg 4 msg per mo. You may receive up to 17 text messages during the course of this
offer. Offer valid for patients who have been prescribed Nasacort AQ. Void where prohibited by law, taxed, or restricted. Offer
not valid for prescriptions reimbursed or paid under Medicare, Medicaid, or any government (public insurance) programs, or in
the state of Massachusetts. Other restrictions may apply.
Click here for full Terms and Conditions.