There are two coupons for Daliresp :

#1

Daliresp™ Coupon; Save $20 Of The Cost Of Your Next Prescription For Daliresp (roflumilast); Doctor Distributed

Name of Offer: Daliresp Copay Assistance Program
Description:

Daliresp™ Coupon Coupon; Save $20 Per Prescription; Manufacturer Offer
Launch Coupon; Doctor Distributed Reusable Coupon Card

Details: Daliresp is a new medication for COPD. Daliresp coupons are part of a comprehensive program designed to increase the likeliehood of a positive outcome regarding Daliresp (roflumilast) therapy.

Pharmaceutical sales representatives are distributing these coupons in large quantities to doctors that treat COPD patients.

If your doctor does not have a supply of these cards, he needs to contact Forest Laboratories.

Not all doctors qualify to participate in this program.

Other Misc:
- Patient pays the first $20.
- Maximum value of Daliresp coupon is $20 per prescription ($240 per year).
- Daliresp coupon patient help line is 1-866-271-5502.
- Daliresp coupon expiration date is 11/30/2012.
- Daliresp coupon may be used once every 25 days with a maximum of 12 coupon transactions per year or until the program expiration date, whichever comes first.
- Limit 1 card per patient for the lifetime of the program.

Daliresp Coupon Processing Credentials:
Bin: 004 682
RxPCN: CN
Group ID: EC 4800 3001
ID#: Each card has a unique ID number

Daliresp Coupon Submission Process:
Submit claim to the patient's Primary Payer first, then submit the balance due to Therapy Plus as a secondary Payer as a copay only billing using a valid Other Coverage Code (EG 8).
- Daliresp coupon adjudicated by PSKW, LLC on behalf of Forest Laboratories.
Pharmacist help line is 1-800-422-5604; please have your NABP number handy when Daliresp coupon group number handy.

#2

Daliresp Reusable Buying Group Coupon (Free - No Membership Fees)

Save up to 75% off Retail Price

Daliresp
Reusable Buying Group Coupon
  • Name: ________________________________
  • RxMBR: 10 Digit Phone Number
  • RxBin: 610709
  • RxPCN: 7777
  • RxGRP: EDRUGCOUPON
  • Program: UNA RX CARD - UNITED NETWORKS OF AMERICA
  • Discount program for drugs similar to how the AAA card gets you discounts on motel rooms.
  • Ideal for people with no drug coverage, self employed, donut hole seniors.
  • Accepted at all the big chains (Walgreens, CVS, Rite Aid, Etc.) and most independent pharmacies. Not to be combined with insurance, great for drugs not covered by your plan.
  • Click here for price quote from drugstore near you that participates in this program.
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