Patient Instructions: In order to redeem this card you must have a valid prescription for Stendra® (Avanafil) tablets. Eligible insured patients will pay the first $15 and the card will pay up to $25 for each tablet up to a maximum of 18 tablets. Eligible cash patients will receive up to $30 off per tablet up to a maximum of 18 tablets. Offer valid for up to 15 uses. Follow the dosage instructions given by the doctor. Prescriber ID# required on prescription.
Restrictions: This coupon is not insurance. This coupon is valid for patients with private insurance or cash paying patients. This card is not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare, Medicare Part D, Medigap, VA, DOD, TRICARE/CHAMPUS, or any other state or federal medical or pharmaceutical benefit program or pharmaceutical assistance program. This offer is not valid for those under 18 years of age. This card may not be redeemed for cash. Cardholders with questions, please call 1-844-274-2837.
Pharmacist instructions for a patient with an eligible third party payer: Submit the claim to the primary third party payer first, then submit the balance due to Change Healthcare as a secondary payer COB [coordination of benefits] with patient responsibility amount and a valid Other Coverage Code, (e.g. 8). The patient pays the first $15 and the card will pay up to $25 for each tablet up to a maximum of 18 tablets. Reimbursement will be received from Change Healthcare.
Pharmacist instructions for a cash-paying patient: Submit this claim to Change Healthcare. A valid Other Coverage Code (e.g. 1) is required. The patient pays amount submitted will be reduced by up to $30 per tablet up to a maximum of 18 tablets and reimbursement will be received from Change Healthcare.
Valid Other Coverage Code required. For any questions regarding Change Healthcare online processing, please call the Help Desk at 1-800-422-5604. Program managed by ConnectiveRx on behalf of METUCHEN Pharmaceuticals. METUCHEN reserves the right to rescind, revoke, or amend this offer without notice at any time. Not valid if reproduced. Void where prohibited by law.