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CONCERTA® Savings Program Eligible Patients can pay $4

CONCERTA® Savings Program Eligible Patients can
pay $4

I read, understand, and agree to the program requirements shown below and would like to receive a CONCERTA® (methylphenidate HCl) Extended-release Tablets CII Savings Program card.

Download and print the card and present it at a participating retail pharmacy along with a valid prescription. Your eligibility to use this card is dependent upon meeting the program requirements each time you present the card when filling your prescription.

Program description:

Eligible patients using commercial or private insurance can save on out-of-pocket costs for CONCERTA®.  Eligible patients pay an initial $4 per fill at participating retail pharmacies and receive up to $150 off their out-of-pocket prescription costs, with a maximum program benefit of $1,800 or 12 fills per calendar year, whichever comes first.  Not valid for patients using Medicare, Medicaid, or other government-funded programs to pay for their medications. Terms expire at the end of each calendar year and may change.  Offer not valid in CA and MA.  There is no income requirement.  See program requirements below.

Program Requirements:

You may be eligible for the CONCERTA® Savings Program if you are age 6 to 65 and currently use private or commercial health insurance for CONCERTA®.

  • This program is only available to individuals age 6 to 65 using commercial or private health insurance for their Janssen medication, including plans available through state and federal healthcare exchanges. This program is not available to individuals who use any state or federal government-funded healthcare program to cover a portion of medication costs, such as Medicare, Medicaid, TRICARE, Department of Defense, or Veterans Administration.
  • Out-of-pocket costs paid by this program may not be submitted as a claim for payment to any third-party payer, pharmaceutical patient assistance foundation, or account such a Flexible Spending Account (FSA), a Health Savings Account (HSA), or a Health Reimbursement Account (HRA).
  • Your eligibility to use the CONCERTA® Savings Program card is subject to meeting the program requirements at the time of each use.
  • Program terms will expire at the end of each calendar year.  Program subject to change or discontinuation without notice, including in specific states.  Offer not valid in CA and MA.
  • As a condition of participating in this program, you must ensure that you comply with any co-payment disclosure requirements of your insurance carrier or third-party payer, including disclosing to your insurer the amount of co-payment support you receive from this program. By using the CONCERTA® Savings Program card, you confirm that you have read, understood and agree to the program requirements shown on this page.
  • This program offer may not be combined with any other coupon, discount, prescription savings card, free trial, or other offer. The selling, purchasing, trading, or counterfeiting of this card is prohibited.  Offer good only in the United States and its territories, excluding states noted above.  Void where prohibited, taxed, or otherwise restricted by law.

This program is in no way an extension of medical treatment provided by healthcare professionals to individual patients.

If you wish to participate in the CONCERTA® Savings Program, we will not collect your personal information before you receive a card. Upon use of the card, your information will be used by Janssen Pharmaceuticals, Inc., our affiliates, and our service providers to determine your eligibility for the CONCERTA® Savings Program, and to provide benefits to you related to the use of the CONCERTA® Savings Program card. We may also use the information you provide to learn more about the people who use CONCERTA® and to improve the information we provide to people who are being treated with CONCERTA®. Janssen Pharmaceuticals, Inc. will not share your information with anyone else except as required by law. Our Privacy Policy governs the use of information you provide.

IMPORTANT SAFETY INFORMATION

Talk to your healthcare professional for a proper diagnosis and treatment of ADHD. Only a healthcare professional can decide whether medication is right for you or your child.

Abuse of methylphenidate may lead to dependence. Tell your healthcare professional if you or your child has had problems with alcohol or drugs. Keep CONCERTA® in a safe place to prevent misuse and abuse.

Who should not take CONCERTA®?

CONCERTA® should not be taken by patients who have:

  • allergies to methylphenidate or other ingredients in CONCERTA®
  • significant anxiety, tension or agitation
  • glaucoma
  • tics, Tourette’s syndrome or family history of Tourette’s syndrome
  • current or past use of monoamine oxidase inhibitor (MAOI)
  • esophagus, stomach or intestinal narrowing

Children under 6 years of age should not take CONCERTA®.

Tell your healthcare professional if you or your child has had:

  • any heart problems, heart defects, high blood pressure or a family history of these problems
  • has had depression, abnormal thoughts or visions, bipolar disorder, or seizures
  • numbness, pain, skin color change or sensitivity to temperature in fingers or toes

Contact your healthcare professional immediately if you or your child:

  • develops abnormal thinking or hallucinations, abnormal or extreme moods and/or excessive activity
  • if aggressive behavior or hostility develops or worsens while taking CONCERTA®

Painful and prolonged erections (priapism) have occurred with methylphenidate. If you or your child develop priapism, seek medical help right away. Because of the potential for lasting damage, priapism should be evaluated by a doctor immediately.

Your child’s healthcare professional should check height and weight often and may interrupt CONCERTA® treatment if your child is not growing or gaining weight as expected.

Stimulants may impair the ability of a patient to operate potentially hazardous machinery or vehicles. Caution should be used accordingly until you are reasonably certain that CONCERTA® does not adversely affect your ability to engage in such activities.

The most common adverse reactions in double-blind clinical trials (>5%) reported:

  • in children and adolescents was upper abdominal pain
  • in adult patients were decreased appetite, headache, dry mouth, nausea, trouble sleeping, anxiety, dizziness, weight decreased, irritability and increased sweating

CONCERTA® is a registered trademark of ALZA Corporation.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Please see the full Prescribing Information including Boxed WARNING and the Medication Guide for CONCERTA®.

cp-180018v1

INDICATION

CONCERTA® (methylphenidate HCl) Extended-release Tablets CII is a prescription medication approved for the treatment of attention deficit hyperactivity disorder (ADHD) as part of a total treatment program that may include counseling or other therapies.

IMPORTANT SAFETY INFORMATION

Talk to your healthcare professional for a proper diagnosis and treatment of ADHD. Only a healthcare professional can decide whether medication is right for you or your child.

Abuse of methylphenidate may lead to dependence. Tell your healthcare professional if you or your child has had problems with alcohol or drugs. Keep CONCERTA® in a safe place to prevent misuse and abuse.

Who should not take CONCERTA®?

CONCERTA® should not be taken by patients who have:

  • allergies to methylphenidate or other ingredients in CONCERTA®
  • significant anxiety, tension or agitation
  • glaucoma
  • tics, Tourette’s syndrome or family history of Tourette’s syndrome
  • current or past use of monoamine oxidase inhibitor (MAOI)
  • esophagus, stomach or intestinal narrowing

Children under 6 years of age should not take CONCERTA®.

Tell your healthcare professional if you or your child has had:

  • any heart problems, heart defects, high blood pressure or a family history of these problems
  • has had depression, abnormal thoughts or visions, bipolar disorder, or seizures
  • numbness, pain, skin color change or sensitivity to temperature in fingers or toes

Contact your healthcare professional immediately if you or your child:

  • develops abnormal thinking or hallucinations, abnormal or extreme moods and/or excessive activity
  • if aggressive behavior or hostility develops or worsens while taking CONCERTA®

Painful and prolonged erections (priapism) have occurred with methylphenidate. If you or your child develop priapism, seek medical help right away. Because of the potential for lasting damage, priapism should be evaluated by a doctor immediately.

Your child’s healthcare professional should check height and weight often and may interrupt CONCERTA® treatment if your child is not growing or gaining weight as expected.

Stimulants may impair the ability of a patient to operate potentially hazardous machinery or vehicles. Caution should be used accordingly until you are reasonably certain that CONCERTA® does not adversely affect your ability to engage in such activities.

The most common adverse reactions in double-blind clinical trials (>5%) reported:

  • in children and adolescents was upper abdominal pain
  • in adult patients were decreased appetite, headache, dry mouth, nausea, trouble sleeping, anxiety, dizziness, weight decreased, irritability and increased sweating

CONCERTA® is a registered trademark of ALZA Corporation.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Please see the full Prescribing Information including Boxed WARNING and the Medication Guide for CONCERTA®.

cp-180018v1

+
INDICATION

CONCERTA® (methylphenidate HCl) Extended-release Tablets CII is a prescription medication approved for the treatment of attention deficit hyperactivity disorder (ADHD) as part of a total treatment program that may include counseling or other therapies.