PATIENT SAVINGS

Eligible Commercially Insured Patients Can Receive UP TO 12 MONTHS of BEVESPI AEROSPHERE for FREE*

BEVESPI Coupon Savings Card BEVESPI Coupon Savings Card
Eligible commercially insured patients will pay as little as $0* with the BEVESPI AEROSPHERE Zero-Pay Program.
Help reduce your patients’ prescription costs. Share the BEVESPI AEROSPHERE Zero-Pay Program with your patients.*

*Restrictions apply. See full eligibility information below.

*Restrictions apply. See full eligibility information below.

 
 
BEVESPI AEROSPHERE SAVINGS PROGRAM

ELIGIBILITY

You may be eligible for this offer if you are insured by commercial insurance and your insurance does not cover the full cost of your prescription, or you are not insured and are responsible for the cost of your prescriptions.

Patients who are enrolled in a state or federally funded prescription insurance program are not eligible for this offer. This includes patients enrolled in Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DOD) programs or TriCare, and patients who are Medicare eligible and enrolled in an employer-sponsored group waiver health plan or government-subsidized prescription drug benefit program for retirees.

If you are enrolled in a state or federally funded prescription insurance program, you may not use this savings card even if you elect to be processed as an uninsured (cash-paying) patient.

This offer is not insurance, is restricted to residents of the United States and Puerto Rico, and to patients over 18 years of age, subject to label indication. [If you use a mail-order pharmacy, please contact your pharmacy provider to confirm if this offer will be accepted.]

TERMS OF USE

Eligible commercially insured/covered patients with no restrictions (step-edit, prior authorization, or NDC block) and with a valid prescription for BEVESPI AEROSPHERE® (glycopyrrolate 9 mcg/formoterol fumarate 4.8 mcg) who present this savings card at participating pharmacies will receive 100% off their out-of-pocket costs for each covered [30-, 60-, or 90-day supply (1-3 inhaler(s), respectively)]. If you pay cash for your prescription, or are insured and your insurance does not cover or has a managed care restriction on your prescription (step-edit, prior authorization, or NDC block), you will receive up to $[100] in savings on your out-of-pocket costs for each inhaler. This offer is good for 12 uses and each inhaler counts as 1 use. Patient is responsible for applicable taxes, if any. If you have any questions regarding this offer, please call [1-844-327-3401].

Non-transferable, limited to one per person, cannot be combined with any other offer. Void where prohibited by law, taxed, or restricted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer.

AstraZeneca reserves the right to rescind, revoke, or amend this offer, eligibility, and terms of use at any time without notice. This offer is not conditioned on any past, present, or future purchase, including refills.

Offer must be presented along with a valid prescription for BEVESPI AEROSPHERE at the time of purchase.

If your commercial insurance plan does not cover BEVESPI AEROSPHERE, use of this offer permits your health care provider or pharmacy to share limited information with certain AstraZeneca vendors to determine if additional resources may be available to you; and to act on your behalf to initiate any processes that may be necessary to access these resources.

BY USING THIS CARD, YOU AND YOUR PHARMACIST UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

Program managed by ConnectiveRx, on behalf of AstraZeneca.

 

IMPORTANT SAFETY INFORMATION, INCLUDING BOXED WARNING

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IMPORTANT SAFETY INFORMATION, INCLUDING BOXED WARNING

WARNING: Long-acting beta2-adrenergic agonists (LABAs), such as formoterol fumarate, one of the active ingredients in BEVESPI AEROSPHERE, increase the risk of asthma-related death. A placebo-controlled trial with another LABA (salmeterol) showed an increase in asthma-related deaths in subjects receiving salmeterol. This finding with salmeterol is considered a class effect of all LABAs, including formoterol fumarate.

The safety and efficacy of BEVESPI AEROSPHERE in patients with asthma have not been established. BEVESPI AEROSPHERE is not indicated for the treatment of asthma.

CONTRAINDICATIONS

All LABAs are contraindicated in patients with asthma without use of a long-term asthma control medication. BEVESPI is contraindicated in patients with hypersensitivity to glycopyrrolate, formoterol fumarate, or to any component of the product.

WARNINGS AND PRECAUTIONS

  • BEVESPI should not be initiated in patients with acutely deteriorating chronic obstructive pulmonary disease (COPD), which may be a life-threatening condition

  • BEVESPI should not be used for the relief of acute symptoms (ie, as rescue therapy for the treatment of acute episodes of bronchospasm). Acute symptoms should be treated with an inhaled short-acting beta2-agonist

  • BEVESPI should not be used more often or at higher doses than recommended, or with other LABAs, as an overdose may result

  • If paradoxical bronchospasm occurs, discontinue BEVESPI immediately and institute alternative therapy

  • If immediate hypersensitivity reactions occur, in particular, angioedema, urticaria, or skin rash, discontinue BEVESPI at once and consider alternative treatment

  • BEVESPI can produce a clinically significant cardiovascular effect in some patients, as measured by increases in pulse rate, blood pressure, or symptoms. If such effects occur, BEVESPI may need to be discontinued

  • Use with caution in patients with convulsive disorders, thyrotoxicosis, diabetes mellitus, ketoacidosis, and in patients who are unusually responsive to sympathomimetic amines

  • Be alert to hypokalemia and hyperglycemia

  • Worsening of narrow-angle glaucoma or urinary retention may occur. Use with caution in patients with narrow-angle glaucoma, prostatic hyperplasia, or bladder-neck obstruction, and instruct patients to contact a physician immediately if symptoms occur

ADVERSE REACTIONS

The most common adverse reactions with BEVESPI (≥2% and more common than placebo) were: cough, 4.0% (2.7%), and urinary tract infection, 2.6% (2.3%).

DRUG INTERACTIONS

  • Use caution if administering additional adrenergic drugs because the sympathetic effects of formoterol may be potentiated

  • Concomitant treatment with xanthine derivatives, steroids, or diuretics may potentiate any hypokalemic effect of formoterol

  • Use with caution in patients taking non–potassium-sparing diuretics, as the ECG changes and/or hypokalemia may worsen with concomitant beta2-agonists

  • The action of adrenergic agonists on the cardiovascular system may be potentiated by monoamine oxidase inhibitors, tricyclic antidepressants, or other drugs known to prolong the QTc interval. Therefore, BEVESPI should be used with extreme caution in patients being treated with these agents

  • Use beta-blockers with caution as they not only block the therapeutic effects of beta-agonists, but may produce severe bronchospasm in patients with COPD

  • Avoid co-administration of BEVESPI with other anticholinergic-containing drugs as this may lead to an increase in anticholinergic adverse effects

INDICATION

BEVESPI AEROSPHERE is a combination of glycopyrrolate, an anticholinergic, and formoterol fumarate, a long-acting beta2-adrenergic agonist (LABA), indicated for the long-term, maintenance treatment of airflow obstruction in patients with COPD, including chronic bronchitis and/or emphysema.

LIMITATION OF USE

Not indicated for the relief of acute bronchospasm or for the treatment of asthma.

Please read full Prescribing Information, including Boxed WARNING, and Medication Guide and Instructions for Use for BEVESPI AEROSPHERE.

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