Terms and conditions for patients:
Patients are not eligible if their prescriptions are paid in part or full by any state or federally funded programs, including but not limited to Medicare or Medicaid, VA, DOD, or TriCare and where prohibited by law. This card is not valid where prohibited by law. Card cannot be combined with any other rebate/coupon, free trial, or similar offer. Use of the card will allow the consumer to pay a $20 or $50 out-of-pocket maximum per prescription depending on prescription filled. Maximum benefits apply. Offer good only in the USA and cannot be redeemed at government-subsidized clinics. Aqua Pharmaceuticals reserves the right to rescind revoke, or amend this offer without notice. You understand and agree to comply with the terms and conditions of this offer as set forth above.
This program is not health insurance.
This program is available at participating pharmacies.
Aqua Pharmaceuticals retains the right to rescind, revoke, or change the benefit at any time.
By using the SuccessFill™ card, I agree to the terms and conditions of this program.
You are encouraged to report negative side effects of prescription drugs to the FDA.
Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.