Save On Your BenzaClin® Prescription

How to save on your BenzaClin® prescriptions*

Insured Patients
Pay no more than $20 on your BenzaClin® prescription.^†

Cash-Paying Patients
Save $25 on your BenzaClin® prescription.

If you are using a mail order pharmacy, you must comply with that mail order pharmacy’s rules. It is usually helpful to check with your plan to be certain what these rules are. If the mail order pharmacy will not process your coupon or if your pharmacist cannot process your coupon, please follow these simple steps:

1. Call 1-877-264-2440 and request to speak to an agent.

2. Request a Direct Member Reimbursement (DMR) form, which will be mailed to you.

3. Complete the form and return to the address on the form, along with your pharmacy receipt.

4. If you are eligible, your benefit will be sent to you in the mail.

ELIGIBILITY REQUIREMENTS AND LEGAL DISCLAIMERS:
This coupon is valid for prescriptions of any BenzaClin® product and is valid only in the United States. Offer not valid for prescriptions reimbursed or paid under Medicaid, Medicare, or any other similar federal or state health care program, including any medical or pharmaceutical assistance program. Void in Massachusetts if any insurer or other third party payer reimburses you or pays for any part of the prescription price. Offer void where prohibited by law, taxed, or restricted. You are responsible for reporting receipt of a coupon to any private insurer that pays for or reimburses you for any part of the prescription fill. This coupon may not be reproduced. Dermik Laboratories reserves the right to rescind, revoke, or amend this offer at any time without notice. This offer starts December 1st, 2011 and expires December 31st, 2011. Customer inquiries please call 1-877-264-2440. For more information on BenzaClin®, visit benzaclin.com.

To the Patient: You must present this coupon to the pharmacist along with your prescription to participate in this program. If you have any questions regarding your eligibility or benefits, or if you wish to discontinue your participation, call the BenzaClin® Instant Savings program at 1-877-264-2440 (8:00 AM-8:00 PM EST, Monday-Friday). When you use this coupon, you are certifying that you understand the program rules, regulations, and terms and conditions. You are not eligible if prescriptions are reimbursed or paid under Medicaid, Medicare, or any other similar federal or state health care program, including any medical or pharmaceutical assistance program. Void in Massachusetts if any insurer or other third party payer reimburses you or pays for any part of the prescription price. Offer void where prohibited by law, taxed, or restricted. If prescription is covered by insurance you may need to notify insurer of receipt of discount.

To the Pharmacist: When you use this coupon, you are certifying that you have not submitted and will not submit a claim for reimbursement under any federal, state or other governmental programs for this prescription.

• Submit transaction to McKesson Corporation using BIN #610524
• If primary coverage exists, input coupon information as secondary coverage and transmit using the COB segment of the NCPDP transaction. Applicable discounts will be displayed in the transaction response.
• Acceptance of this coupon and your submission of claims for the BenzaClin® Instant Savings program are subject to the LoyaltyScript® program Terms and Conditions posted at www.mckesson.com/mprstnc
• Offer not valid for prescriptions reimbursed or paid under Medicaid, Medicare, or any other similar federal
  or
  state health care program, including any medical or pharmaceutical assistance program. Void in Massachusetts if any insurer or other third party payer reimburses you or pays for any part of the prescription price. Offer void where prohibited by law, taxed, or restricted.
• For questions regarding setup, claim transmission, patient eligibility or other issues, call the LoyaltyScript® for BenzaClin® Instant Savings program at 1-877-264-2440 (8:00 AM-8:00 PM EST, Monday-Friday).

Important Safety Information for BenzaClin®

You should not use BenzaClin® if you are allergic to clindamycin, benzoyl peroxide, or the antibiotic lincomycin. If allergy symptoms occur such as swelling or shortness of breath, stop using BenzaClin® and call your doctor immediately. Clindamycin, an ingredient in BenzaClin®, may cause diarrhea. You should not use BenzaClin® if you have a history of Crohn’s disease, ulcerative colitis, or antibiotic-associated colitis. Clindamycin taken orally or through IV has been associated with severe colitis, which may result in death. If you experience severe diarrhea or severe abdominal cramps, stop using BenzaClin® and call your doctor immediately.

Please see full important safety information and full prescribing information link below.

BenzaClin® is an acne product you can get with a doctor's prescription. You should not use BenzaClin® if you are allergic to clindamycin, benzoyl peroxide, or the antibiotic lincomycin. If allergy symptoms occur such as swelling or shortness of breath, stop using BenzaClin® and call your doctor immediately. Clindamycin, an ingredient in BenzaClin®, may cause diarrhea. You should not use BenzaClin® if you have a history of Crohn’s disease, ulcerative colitis, or antibiotic-associated colitis. Clindamycin taken orally or through IV has been associated with severe colitis, which may result in death. If you experience severe diarrhea or severe abdominal cramps, stop using BenzaClin® and call your doctor immediately.

BenzaClin® is for topical use only. Do not use with other topical acne products unless directed by your doctor. The most frequently reported side effects in the clinical studies include dry skin, application site reaction, itching, peeling, redness and sunburn.

*Offer good on all BenzaClin® products. This offer is limited to one redemption.

^†Maximum savings up to $65 per redemption.