By replying with a "YES" text message to confirm your participation in Tris ADHD Text Program (the "Program"), you are consenting to the terms and conditions set forth below, both with respect to receiving autodialed text messages sent from or on behalf of Tris Pharma, and to the conditions of the Program Savings Card. You are also affirming that you are at least 18 years of age. This program is not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare, Medicare Part D plans as a supplemental benefit under enhanced alternative coverage, or other federal or state healthcare programs, including any state prescription drug assistance programs and the Government Health Insurance Plan available in Puerto Rico (formerly known as "La Reforma de Salud"). Consent is not a condition of purchase or use of any Tris product. Tris reserves the right to rescind, revoke or amend the Program without notice to you.
As a Program participant, you may receive approximately 5 messages per month during the course of your participation in the Program, actual message frequency varies by user. The Program is valid with most major US carriers. There is no fee charged to you for receiving Program messages that is payable to Tris or anyone acting on its behalf; however, your carrier's message and data rates may apply. You may unsubscribe from the Program at any time by texting STOP. For help, text HELP.
This offer is valid toward one of the following products: • DYANAVEL XR • QUILLIVANT XR • QUILLICHEW ER
See Prescribing Information for DYANAVEL® XR (amphetamine) • QUILLIVANT XR® (methylphenidate HCl) • QUILLICHEW ER® (methylphenidate HCl), including Boxed Warning about Abuse and Dependence, and Medication Guide.
*With the Tris Co-pay Savings Card, eligible commercially-insured and cash-paying patients can lower their out-of-pocket costs for their prescription. Eligible patients may pay as little as $25 on each prescription. Cash patients and patients without product coverage will pay $50 for their first prescription. Program benefit calculated on FDA-approved dosing. A valid Prescriber ID# is required on the prescription. Patients with questions about the Tris Savings offer should call 1-888-840-7006.
Pharmacist: When you apply this offer, you are certifying that you have not submitted a claim for reimbursement under any federal, state, or other governmental programs for this prescription. Participation in this program must comply with all applicable laws and regulations as a pharmacy provider. By participating in this program, you are certifying that you will comply with the terms and conditions described in the Restrictions section below.
Pharmacist instructions for insured patients: Submit the claim to the primary Third Party Payer first, then submit the balance due to Change Healthcare as a Secondary Payer as a copay-only billing using a valid Other Coverage Code, (e.g. 8, 3). The patient may pay as little as $25 and the card pays up to the maximum benefit. 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. 0, 1) is required. The card pays up to the maximum allowable benefit; the patient is responsible for any remaining balance due after savings offer has been applied. Reimbursement will be received from Change Healthcare. For any questions regarding Change Healthcare online processing, please call the Help Desk at 1-800- 422-5604.
Restrictions: This offer is valid in the United States. Offer not valid for prescriptions reimbursed under Medicaid, a Medicare drug benefit plan, TRICARE, or other federal or state health programs (such as medical assistance programs). Cash Discount Cards and other non-insurance plans are not valid as primary under this offer. If the patient is eligible for drug benefits under any such program, the patient cannot use this offer. By using this offer, the patient certifies that he or she will comply with any terms of his or her health insurance contract requiring notification to his or her payer of the existence and/or value of this offer. It is illegal to (or offer to) sell, purchase, or trade this offer. This offer is not transferable and is limited to one offer per person. Not valid if reproduced. Void where prohibited by law. Tris Pharma reserves the right to rescind, revoke, or amend this offer without notice at any time.
If you and your doctor decide that a different Tris product is right for you or your child, you may be eligible to receive the first fill at no cost.* Please call 1-888-840-7006 for more information.
*First fill of new medication at no cost, remaining fills subject to the original terms and conditions.
The health information contained herein is provided for educational purposes only and is not intended to replace discussions with a healthcare professional. All decisions regarding patient care must be made with a healthcare professional, considering the unique characteristics of the patient.