get your free g iv e y ou rph am cst th ed s to receive ... · get your free†* contour®next ez...

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Get your FREE †* CONTOUR ® NEXT EZ Meter Take this coupon to a participating pharmacy today! *with the purchase of CONTOUR ® NEXT test strips. Limitations and restrictions apply. Valid for eligible privately insured patients only. Give your pharmacist these codes to receive your free meter: RxBin # RxPCN # RxGroup # Group ID # Exp Date 015251 PRX2000 NTX70 NXT79892116 12/31/2018 For more information, visit ContourNext.com or call 1-800-348-8100. Limitations & Restrictions apply. This offer must be accompanied by a prescription for a CONTOUR ® NEXT, CONTOUR ® or generic meter. Offer should not be available to government beneficiaries, unless they are on a managed care plan and free meters are provided under the agree- ment. Contact the patient’s physician if no prescription is on file. Ascensia reserves the right to terminate the program without notice. These products are provided for evaluation purposes only and may not be charged to any patient and the provider may not submit a claim for reimbursement to Medicare, Medicaid, or other public or private insurer for the sample product. Void where prohibited by law. To the Pharmacist: • The identification number above can be used for all patients. • Limit 1 meter per patient, per 12 month period for purchase of product indicated. • This offer cannot be redeemed for cash, or combined with any other offer, coupon, or discount. • Ascensia reserves the right to terminate the program without notice. • Transmit claim on-line to OPTUMRx. For assistance in filing this claim contact the Help Desk at 1-800-510-4836. • This offer must be accompanied by a prescription for a CONTOUR ® NEXT unbranded meter. Contact physician if no prescription on file. • Processor requires valid Prescriber ID#, Patient Name, and DOB for claim adjudication. • These products are provided for evaluation purposes only and may not be charged to any patient and the provider may not submit a claim for reimbursement to Medicare, Medicaid, or other public or private insurer for the sample product. • Offer void where prohibited by law.

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Page 1: Get your FREE G iv e y ou rph am cst th ed s to receive ... · Get your FREE†* CONTOUR®NEXT EZ Meter Take this coupon to a participating pharmacy today! *with the purchase of CONTOUR®NEXT

Get your FREE†*

CONTOUR®NEXT EZ Meter

Take this coupon to a participating pharmacy today!

* with the purchase of CONTOUR®NEXT test strips.Limitations and restrictions apply. Valid for eligible privatelyinsured patients only.

Give your pharmacist these codes to receive your free meter:

RxBin # RxPCN # RxGroup # Group ID # Exp Date

015251 PRX2000 NTX70 NXT79892116 12/31/2018

For more information, visit ContourNext.com or call 1-800-348-8100.

† Limitations & Restrictions apply. This offer must be accompanied by a prescription for a CONTOUR®NEXT, CONTOUR® or generic meter. Offer should not be available to government beneficiaries, unless they are on a managed care plan and free meters are provided under the agree-ment. Contact the patient’s physician if no prescription is on file. Ascensia reserves the right to terminate the program without notice. These products are provided for evaluation purposes only and may not be charged to any patient and the provider may not submit a claim for reimbursement to Medicare, Medicaid, or other public or private insurer for the sample product. Void where prohibited by law.

To the Pharmacist:• The identification number above can be used for all patients.• Limit 1 meter per patient, per 12 month period for purchase of product indicated.• This offer cannot be redeemed for cash, or combined with any other offer, coupon,

or discount. • Ascensia reserves the right to terminate the program without notice. • Transmit claim on-line to OPTUMRx. For assistance in filing this claim contact the

Help Desk at 1-800-510-4836. • This offer must be accompanied by a prescription for a CONTOUR®NEXT unbranded meter. Contact

physician if no prescription on file. • Processor requires valid Prescriber ID#, Patient Name, and DOB for claim adjudication. • These products are provided for evaluation purposes only and may not be charged to any patient

and the provider may not submit a claim for reimbursement to Medicare, Medicaid, or other public or private insurer for the sample product.

• Offer void where prohibited by law.