Complete eligibility rules:

The Free Trial Offer and participation in the Vantage Program from VESIcare are subject to eligibility. Restrictions may apply. Only people receiving their first prescription for VESIcare 5 mg are eligible for a Free Trial Offer. If you have already filled a prescription for VESIcare, you may be eligible to receive a $25 savings coupon good on your next prescription of VESIcare. The complete eligibility rules are below:

Eligibility for Free Trial Offer:

You may use this voucher only for free product. In order to be eligible for this offer, this voucher must be accompanied by a valid, signed prescription for 30 tablets of VESIcare 5 mg. Further, you are NOT eligible for this offer if you are enrolled in Part D of Medicare, Medicaid, or any similar healthcare program, including any state pharmaceutical assistance program. Also, you are NOT eligible for this offer if this prescription will be submitted for reimbursement under any private insurance, HMO, or other third-party payment arrangement. Only an original voucher will be accepted and must be presented to your pharmacist at the time you have your prescription filled— not valid if reproduced. Offer good only in USA. Void where prohibited by law, taxed, or restricted. No purchase required. May not be used with any other discount, voucher, or other offer. Astellas Pharma US, Inc. reserves the right to rescind, revoke, or amend this coupon without notice.

By tendering this voucher, I, the patient, certify that: (i) I have read the above terms to meet the criteria listed above, (ii) I am not being reimbursed by, nor will I submit a claim for reimbursement to, any third-party payer, nor will I seek any portion of this prescription counted toward my out-of -pocket costs under any federal, state, or private programs for this prescription, and (iii) I will otherwise comply with the terms above.

Eligibility for up to $25 savings coupon

Present this coupon, and, if applicable, your insurance card, with your prescription for VESIcare at any participating pharmacy. You will receive up to $25 off your out-of-pocket cost (the amount you pay after the insurance deductions). You CANNOT use this offer if you are enrolled in Part D of Medicare, Medicaid, or any similar federal or state program, including a state pharmaceutical assistance program. Also, you CANNOT use this offer if you are eligible for Medicare and you are also enrolled in an employersponsored health plan or prescription drug benefit program for retirees (that is, you are eligible for Medicare Part D, but you receive a prescription drug benefit through a former employer). Further, if you are a resident of Massachusetts, this offer is valid only if you are paying the entire cost of the prescription yourself (i.e., your insurance does not cover any of the cost of your prescription). Your acceptance of this offer must be consistent with the terms of any drug benefit provided by your health insurer, health plan, or private third-party payer, as may be required. This offer may not be used with any other discount, coupon, or offer. Only an original coupon will be accepted and must be presented to your pharmacist at the time you have the prescription filled— not valid if reproduced. Offer good only in USA, excluding Puerto Rico. Not transferable. Void where prohibited by law, taxed, or restricted. Limit 1 per purchase. Astellas Pharma US, Inc. reserves the right to rescind, revoke, or amend this coupon without notice.

By tendering this coupon, I, the Patient certify that: (i) I have read the above terms, (ii) I meet the eligibility criteria listed above, and (iii) I will otherwise comply with the terms above.

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