Here is your $0 co-pay card to help you stay prepared.
EpiPen® (epinephrine) Auto-Injector Co-pay Card Terms and Conditions
Present your card along with a valid prescription for the EpiPen 2-Pak® or EpiPen Jr 2‑Pak®.
Maximum benefit of $100 per EpiPen 2-Pak where applicable. This offer may be used on up to three EpiPen 2-Pak
cartons per prescription. This offer can be used an unlimited number of times until the offer
expires on 12/31/2014. Patients with questions should call 1-855-859-2971.
Pharmacist instructions for a patient with an Eligible Third Party Payer:
Submit the claim to the primary Third Party Payer first and then submit the balance due to Therapy First Plus
as a Secondary Payer coordination of benefits with patient responsibility amount and a valid Other Coverage
Code (e.g., 8). Maximum benefit of $100 per EpiPen 2-Pak where applicable. The card pays up to $100 per each
EpiPen 2-Pak and the patient is responsible for the balance. Reimbursement will be received from Therapy First Plus.
Pharmacist instructions for a cash paying patient:
Submit the claim to Therapy First Plus. A valid Other Coverage Code (e.g., 1) is
required. Maximum benefit of $100 per EpiPen 2-Pak where applicable. Reimbursement will be received from
Therapy First Plus.
Valid Other Coverage Code required:
For any questions regarding Therapy First Plus online processing, please call the
Help Desk at 1-800-422-5604.
*This offer is not available to patients that are in Medicare, Medicaid, TRICARE, or any other federal or
state health care plan. The card is not transferable and the amount of the rebate cannot exceed the patient's
out-of-pocket expenses. Program expires 12/31/2014. Program managed by PSKW, LLC on
behalf of Mylan Specialty L.P. Product dispensed pursuant to program rules, and federal and state laws. Offer
is valid for residents of the United States and its territories. The parties reserve the right to amend or
end this program at any time without notice.
EpiPen® (epinephrine) 0.3 mg and EpiPen Jr® (epinephrine) 0.15 mg Auto-Injectors are for the
emergency treatment of life-threatening allergic reactions (anaphylaxis) caused by allergens, exercise, or
unknown triggers; and for people who are at increased risk for these reactions. EpiPen and EpiPen Jr are
intended for immediate self‑administration as emergency supportive therapy only. Seek immediate emergency
medical treatment after use.
Important Safety Information
EpiPen Auto-Injectors contain a single dose of epinephrine, which you inject into your outer thigh. DO NOT
INJECT INTO YOUR VEIN, BUTTOCK, FINGERS, TOES, HANDS OR FEET. In case of accidental injection, please seek
immediate medical treatment. Epinephrine should be used with caution if you have heart disease or are taking
certain medicines that can cause heart-related (cardiac) symptoms.
Tell your doctor if you have certain medical conditions such as asthma, depression, thyroid disease,
Parkinson's disease, diabetes, high blood pressure and heart disease, have any other medical conditions, are
pregnant or plan to become pregnant, or are breastfeeding or plan to breastfeed. Be sure to also tell your
doctor all the medicines you take, especially medicines for asthma. If you have certain
medical conditions, or take certain medicines, your condition may get worse or you may have longer lasting
side effects when you take the EpiPen or EpiPen Jr Auto‑Injector.
The most common side effects may include increase in heart rate, stronger or irregular heartbeat, sweating,
nausea and vomiting, difficulty breathing, paleness, dizziness, weakness or shakiness, headache, apprehension,
nervousness or anxiety. These side effects usually go away quickly, especially if you rest.
Talk to your health care professional to see if EpiPen or EpiPen Jr Auto-Injector is right for you.
Please see the full
Prescribing Information and
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.
For additional information, please contact us at 800-395-3376.