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Name of offer: Ultrase® Rebate; Ultrase® Coupon
Savings: $20.00 cash back
Misc: Obtain Rebate Forms By Calling: 1-800-472-2634
Overview: Send in your reciept with a rebate form and get up to $20 cash back per month
Maximum Savings: $240.00 per year
Information Required: Name, Address, E-mail address, etc, brief survey
1. Have your prescription for ULTRASE® MT filled at your regular pharmacy. Note: Your prescription must be for ULTRASE® MT12, ULTRASE® MT18 or ULTRASE® MT20
(a minimum of 100 ULTRASE® MT capsules is required).
2. Complete a Rebate Claim Coupon (which you may obtain from any CF center or by calling 800-472-2634), and mail it with the original pharmacy receipt to the address on the coupon.
3. You will receive a check (up to $20) in about three weeks for the amount of your out-of-pocket expense. Included with your check will be another Rebate Claim Coupon for use the following month.
Note: You may submit only one Rebate Claim Coupon per month. The Rx Cost Reduction ProgramSM may not be combined with the CareFirst for CFSM or the Comprehensive Care Program for CFSM. Coupons must be fully completed to be processed.
If you have any questions about Axcan products or the Rx Cost Reduction ProgramSM, please call (866)-AXCANRX.
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