To help manage PAH Stay on Track with Letairis

Terms and Conditions

The Letairis Co-pay Coupon Program ("Coupon") can be used only by eligible residents of the U.S., Puerto Rico, or U.S. Territories via Certified Pharmacies who dispense Letairis. Product must originate in the U.S. or Puerto Rico, or U.S. Territories. You must be 18 years or older to use the Coupon for yourself or a minor.

The Coupon is not insurance and is not intended to substitute for insurance.

THE COUPON IS VALID ONLY FOR PATIENTS WITH COMMERCIAL INSURANCE AND IS NOT VALID FOR PRESCRIPTIONS THAT ARE ELIGIBLE TO BE REIMBURSED IN WHOLE OR IN PART BY MEDICARE, A MEDICARE PART D PLAN, MEDICAID, TRICARE, VA, DOD, PUERTO RICO GOVERNMENT HEALTH INSURANCE PLAN, OR ANY OTHER FEDERAL OR STATE-FUNDED HEALTHCARE BENEFIT PROGRAM (COLLECTIVELY, "GOVERNMENT PROGRAMS"); OR BY COMMERCIAL PLANS OR OTHER HEALTH OR PHARMACY BENEFIT PROGRAMS THAT REIMBURSE FOR THE ENTIRE COST OF PRESCRIPTION DRUGS.

Medicare Part D Enrollees who are in the prescription drug coverage gap (the "donut hole") are not eligible for the Coupon. Patients who begin receiving prescription benefits from Government Programs at any time will no longer be eligible to use the Coupon. Void where prohibited by law, taxed, or restricted.

Patient, pharmacist, and prescriber agree not to seek reimbursement for all or any part of the benefit received by the patient through the offer. Both patient and pharmacist are each individually responsible for reporting receipts of Coupon benefit to any insurer, health plan, or other third party who pays for, or reimburses, any part of the prescription filled using the Coupon, as required. It is illegal to sell, purchase, trade, or counterfeit, or offer to sell, purchase, trade, or counterfeit the Coupon.

Certain information pertaining to use of the Coupon will be shared with Gilead, the sponsor of the Coupon, and its affiliates. The information disclosed will include the date the prescription is filled, the number of pills or product dispensed by the pharmacist, and the amount of the co-pay that will be paid for by using the Coupon.