To receive up to $400 in savings towards your out-of-pocket costs on each of up to 12 eligible prescriptions, (regardless of the number of tablets supplied on the prescription) present the coupon and your insurance card with a valid, signed prescription at any participating eligible retail or mail-order pharmacy. The coupon can be used up to 12 times prior to the expiration date. Eligibility restrictions and Terms and Conditions apply.

The Savings Coupon provides savings towards your out-of-pocket costs, up to a maximum of $400 per eligible prescription (regardless of the number of tablets supplied on the prescription) for ISENTRESS. The coupon can be used up to 12 times prior to the expiration date. Eligibility restrictions and Terms and Conditions apply.

The Savings Coupon for ISENTRESS expires 09/30/2012.

Merck reserves the right to rescind, cancel, or amend this offer at any time without notice.

Your doctor or health care professional can visit isentress.com to learn more about the coupon.

It is recommended that you contact your mail order pharmacy in advance to confirm that the coupon will be accepted. The pharmacy must be an eligible pharmacy in the United States or the Commonwealth of Puerto Rico.

If you are eligible to use the coupon and your pharmacy did not accept the Savings Coupon, please call McKesson Inc. at 1-877-264-2440 and request a Direct Member Reimbursement (DMR) form. Original pharmacy receipts from an eligible pharmacy in the United States or the Commonwealth of Puerto Rico must be included with the DMR form in order to be eligible for the Savings Coupon.

You will be required to provide McKesson Inc. with your information and they will mail you a DMR form prepopulated with the patient name, address, and card ID number. Requests for a DMR form must be made within 30 days of purchase. The DMR form must be postmarked within 45 days of purchase.

The patient must have private health insurance to use the coupon.

The patient is not eligible to use the coupon if he/she is covered under Medicaid, Medicare, a Medicare Part D, or Medicare Advantage plan (regardless of whether a specific prescription is covered), TRICARE, CHAMPUS, Government Health Insurance Plan (“Healthcare Reform”), or any other state or federal medical or pharmaceutical benefit program or pharmaceutical assistance program.

Residents of Massachusetts are not eligible to use the coupon. All Terms and Conditions of the coupon must be met.

The Savings Coupon for ISENTRESS^® (raltegravir) Tablets is for patients with private health insurance.

The SUPPORT^TM Program for ISENTRESS is available for those patients who have been prescribed ISENTRESS and do not have insurance coverage. The program provides easy and free reimbursement support services and/or patient assistance for eligible individuals. You can learn more about the SUPPORT^TM Program at isentress.com or by calling the Program's toll free number at 1-800-850-3430.

The Savings Coupon is not available to residents of Massachusetts because of state restrictions.

Yes, the patient must be a resident of the United States or the Commonwealth of Puerto Rico and be privately insured. All Terms and Conditions of the coupon must be met.

However, the patient must not be a resident of Massachusetts. If a person other than the patient is responsible for the out-of-pocket cost for ISENTRESS, neither the patient nor the person responsible for the out-of-pocket cost may be a resident of Massachusetts. All Terms and Conditions of the coupon must be met.

No, if the patient is a resident of the US territories, the patient is not eligible for the Savings Coupon. All Terms and Conditions of the coupon must be met.

McKesson Inc. is the third-party administrator processing the Savings Coupon for ISENTRESS.

If you are eligible to use the coupon and are requesting reimbursement using the DMR process, you must provide all information requested on the form and you must sign and date the DMR form.

Forms that are not filled out completely are not eligible for the reimbursement.

The DMR section of the form is filled out and signed by the patient (or guardian of the patient).

If you are eligible to use the coupon and are requesting reimbursement using the DMR process, the original, completed DMR form and the original pharmacy receipt (that indicates the out-of-pocket cost of ISENTRESS) must be postmarked within 45 days of the purchase date. The DMR form must be requested within 30 days of the purchase date.

To be eligible for the reimbursement, you must submit an original reimbursement form and an original receipt that indicates the out-of-pocket cost of ISENTRESS^® (raltegravir) Tablets.

Photocopies of the DMR form are not accepted. All Terms and Conditions of the coupon must be met.

If you misplaced the DMR form, a new form must be obtained by calling McKesson Inc. at 1-877-264-2440.

As a reminder, DMR forms postmarked more than 45 days after the purchase of ISENTRESS will not be accepted.

If you are under 18 years of age or have a guardian appointed, your guardian may request the reimbursement on your behalf. Your parent/guardian will fill out, sign, and date the “Direct Member Reimbursement” section of the reimbursement form.

The reimbursement check will be mailed directly to the parent/guardian in this case.

Each patient is limited to up to 12 DMR request submissions, 1 for each prescription of ISENTRESS, provided the eligibility criteria and Terms and Conditions are met for each prescription.

Yes, the reimbursement check can be sent to a Post Office Box.

If you qualify, the check will be mailed in approximately 4 to 5 weeks.

The reimbursement check will be mailed via US Postal Service.

No, no one will need to sign for the delivery of the reimbursement check. The reimbursement checks will be mailed via US Postal Service.

You can call McKesson Inc. at 1-877-264-2440 for information on the status of your reimbursement check.

Please call McKesson Inc. at 1-877-264-2440