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Cost Reduction ProgramSM
Information for Patients:
As the providers of ULTRASE® MT and URSO Forte® Scored, it is important to us that the cost of your health care remains as affordable as possible. For this reason, Axcan created the
Rx Cost Reduction ProgramSM.
This program will allow you to receive a rebate for your out-of-pocket expense (up to $20 per month), for a prescription of ULTRASE® MT12, ULTRASE® MT18, ULTRASE® MT20 or URSO Forte® Scored.
How the Program Works:
- Have your prescription for ULTRASE® MT or URSO Forte® Scored filled at your regular pharmacy. Note: Your prescription must be for ULTRASE® MT12, ULTRASE® MT18, ULTRASE® MT20 or URSO Forte® Scored (a minimum of 100 ULTRASE® MT capsules or URSO Forte® Scored tablets is required).
- 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. Please note that the Rx Cost Reduction ProgramSM is not available to patients who are participating in a federally-subsidized pharmacy benefit program, or where otherwise prohibited by federal or state law. Be sure to sign the coupon, certifying that the patient is not a participant in a federally-subsidized pharmacy benefit program. - 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 LifeSM program. Coupons must be fully completed to be processed.
It's that easy. If you have any questions about Axcan products or the Rx Cost Reduction ProgramSM, please call (866)-AXCANRX. Please consult your physician with any questions about your ULTRASE® MT or URSO Forte® Scored medication.
Information for Physicians:
- In an effort to reduce the cost of care, your patients can now receive a rebate up to $20 per month for their out-of-pocket expense for ULTRASE® MT (pancrelipase) or URSO Forte® Scored (ursodiol tablets, USP).
- The prescription must be for ULTRASE® MT12, ULTRASE® MT18, ULTRASE® MT20 or URSO Forte® Scored (a minimum of 100 ULTRASE® MT capsules or URSO Forte® Scored tablets is required). Note: Patients may submit only one Rebate Claim Coupon per month.
- Patients can have their ULTRASE® MT or URSO Forte® Scored prescriptions filled at their regular pharmacy or through the CF Services Pharmacy.
- Rebate checks will be mailed directly to patients along with an additional Rebate Claim Coupon.
- The Rx Cost Reduction ProgramSM is not available to patients who are participating in a federally-subsidized pharmacy benefit program, or where otherwise prohibited by federal or state law. This program may not be combined with the CareFirst for LifeSM program.
- Complete program information for patients is included on the Rebate Claim Coupon.
- Please call (800) 472-2634 with any questions regarding the Rx Cost Reduction ProgramSM.
Click here to download the PDF on how to get started with
the Axcan Rx Cost Reduction ProgramSM. (PDF 1.626 MB)
Axcan Pharma US, Inc. reserves the right to discontinue
or change the program at any time.
For information on the distribution of Axcan products in the United States, please contact:
Roddie Thurman
Manager, Customer Service
Tel: (800) 950-8085
Fax: (205) 991-8426
Contact Customer Service
