Testim® coupon eligibility requirements


ELIGIBILITY REQUIREMENTS


TO THE PATIENT: This coupon can be used whether or not you have insurance for the amount of your out-of-pocket expense for this prescription, up to a maximum of $40 per use. This coupon must be accompanied by a valid, signed prescription for Testim. You are NOT eligible to use this coupon if you are a government beneficiary. You are a government beneficiary if this prescription is covered by or will be submitted for reimbursement under any federal healthcare program, including Medicaid, Medicare (Part D or otherwise), or any similar federal or state programs, including any state pharmaceutical assistance program. Further, you MUST NOT be Medicare eligible and enrolled in an employer-sponsored health plan or employer-sponsored prescription drug benefit plan for retirees (ie, you are eligible for Medicare Part D but receive a prescription drug benefit through a former employer).

Not valid in Massachusetts if AB-rated generic drug is available for the product. Your acceptance of this offer must be consistent with terms of any drug benefit plan provided to you by your health insurer. You agree to report your use of this coupon to your health insurer if required. Only original accepted—not valid if reproduced. One per purchase. May not be used with any other discount or offer. Offer limited to males 18 years of age and older. Offer good only in USA. Void where prohibited by law, taxed, or restricted.

Auxilium and McKesson (on behalf of Auxilium) reserve the right to rescind, revoke, or amend this coupon without notice.

By redeeming this coupon, I, the Patient, certify that: (i) I have read and will comply with program rules and requirements, (ii) I have not submitted and will not submit a claim for reimbursement under any federal, state, or other governmental programs for this prescription, and (iii) if I am Medicare eligible, I am not enrolled in an employer-sponsored health plan for retirees or a Medicare Part D Plan.

Mail-order: If you use a mail-order pharmacy, please contact your pharmacy provider to ensure that this offer will be accepted.

This coupon is the property of Auxilium and must be returned upon request.

TO THE PHARMACIST: Please submit the amount of copay authorized by the patient’s primary insurance as a secondary transaction to McKesson Corporation. By redeeming this coupon, I certify that: (i) I have received this coupon from an eligible patient, (ii) I have dispensed the product as indicated, (iii) I have not submitted, and will not submit, a claim for reimbursement to the patient or any federal, state, or other governmental payer or to any Medicare Part D Plan, (iv) I have not retained or provided to any person or entity any portion of the amount being made available to the patient, and (v) I will otherwise comply with the terms hereof. I further certify that my participation in this program is consistent with all applicable state laws and any obligations, contractual or otherwise, that I have as a pharmacy provider. It is a violation of federal law to buy, sell, or counterfeit this coupon.

TO HEALTHCARE PROFESSIONAL: If you are a healthcare professional who resides outside the state of Vermont, but regularly practices in Vermont, please do not download, print, or otherwise accept coupons or vouchers.

What is Testim?

Testim is a prescription medicine that contains testosterone. Testim is used to treat adult males who have low or no testosterone. Your healthcare provider will test your blood before you start and while you use Testim. It is not known if Testim is safe or effective in children younger than 18 years old. Improper use of testosterone in children may affect bone growth.

Testosterone products that are applied to the skin may have different doses, strengths, or application instructions that may lead to different levels of testosterone in your body.

Testim is a controlled substance (CIII) because it contains testosterone that can be a target for people who abuse prescription medicines. Keep your Testim in a safe place to protect it. Testim is not meant for use in women.

IMPORTANT SAFETY INFORMATION

  • Early signs of puberty have happened in young children who were accidentally exposed to testosterone through contact with men using Testim
  • Testim can transfer from your body to others
  • Women and children should avoid contact with the unwashed or unclothed area where Testim has been applied. If a woman or child makes contact with the Testim application area, that area on the woman or child should be washed well with soap and water right away
  • To lower the risk of transfer of Testim from your body to others, you should: Apply Testim only to the areas of your shoulders and upper arms that will be covered by a short sleeve T-shirt and wash your hands right away with soap and water after applying Testim. After the gel has dried, cover the application area with clothing and keep the area covered until you have washed the application area well or have showered. If you expect to have skin-to-skin contact with another person, first wash the application area well with soap and water
  • Stop using Testim and call your healthcare provider right away if you see any signs and symptoms in a child or a woman that may have occurred through accidental exposure to Testim
  • Do NOT apply Testim to the genitals or abdomen
  • Do not use Testim if you: have breast cancer; have or might have prostate cancer; are pregnant or may become pregnant or are breastfeeding. Testim may harm your unborn or breastfeeding baby. Women who are pregnant or who may become pregnant should avoid contact with the area of skin where Testim has been applied
  • Tell your healthcare provider about all the medicines you take. Especially, tell your healthcare provider if you take: insulin, medicines that decrease blood clotting, corticosteroids
  • Testim can cause serious side effects including:
    • If you already have enlargement of your prostate gland your signs and symptoms can get worse while using Testim. These can include changes in urination
    • Possible increased risk of prostate cancer. Your healthcare provider should check you for prostate cancer or any other prostate problems before you start and while you use Testim
    • Blood clots in the legs. This can include pain, swelling or redness of your legs
    • In large doses Testim may lower your sperm count
    • Swelling of your ankles, feet, or body, with or without heart failure. This may cause serious problems for people who have heart, kidney or liver disease
    • Enlarged or painful breasts
    • Having problems breathing while you sleep (sleep apnea)
  • Testim is flammable until dry. Let the Testim dry before smoking or going near an open flame
  • Testim is not interchangeable with other topical testosterone products
  • The most common side effects of Testim include: skin irritation where Testim is applied; increased red blood cell count; headache; increased blood pressure. Other side effects include more erections than are normal for you or erections that last a long time

For more information, talk to your doctor and read the Medication Guide that comes with Testim.

The information on this Web site should not take the place of talking with your doctor or healthcare professional. If you have any questions, talk to your doctor or pharmacist.

You are encouraged to report negative side effects of prescription drugs. Contact Auxilium Pharmaceuticals, Inc. at 1-877-663-0412 or FDA at 1-800-FDA-1088 or www.FDA.gov/medwatch.

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