Sign up for the ORALAIR co-pay assistance program by filling out and submitting the form below. By signing up for a co-pay card, you can get savings to bring your ORALAIR prescription co-pay down to $15, with a maximum monthly benefit of $100. Eligibility restrictions, terms, and conditions apply
Please fill in the information below. Fields or questions marked with an asterisk (*) are required.
Co-pay card for patients with valid prescription for ORALAIR.
Valid for most patients with commercial insurance, as well as for cash-paying patients.
Card valid for 30-day prescriptions.
Card valid for 1 use per month, for up to 10 uses.
Card may be used only by eligible residents of the United States.
This offer is not valid for patients covered, in whole or in part, by any state or federally funded healthcare or pharmacy benefit programs, including but not limited to Medicare, Medicaid, VA, or TRICARE, or any qualified health plan purchased on a state-based, partnership, or federally facilitated exchange.
This offer is not an insurance benefit.
No other purchase is necessary.
Eligible patients may be responsible for deductibles or other out-of-pocket costs, depending on their specific healthcare benefits.
This offer will provide savings in patient’s co-pay cost for ORALAIR only. It does not cover any other healthcare provider charges or any other treatment costs.
Patient, pharmacist, and prescriber agree not to seek reimbursement for all or any part of the benefit received by the patient through this offer.
Patient is responsible for reporting receipt of co-pay assistance to any insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the co-pay card, as may be required.
This offer is nontransferable. No substitutions are permitted. This offer cannot be combined with any other coupon, rebate, free trial, discount, prescription savings card, or other offer.
It is illegal to sell, purchase, trade, or counterfeit, or offer to sell, purchase, trade, or counterfeit, the coupon. Void if reproduced. Void where prohibited by law, taxed, or restricted.
Stallergenes Greer® reserves the right to rescind, revoke, amend, or terminate this offer or the program in its entirety at any time.
ORALAIR® (Sweet Vernal, Orchard, Perennial Rye, Timothy, and Kentucky Blue Grass Mixed Pollens Allergen Extract) is a prescription medicine used for sublingual (under the tongue) immunotherapy prescribed to treat sneezing, runny or itchy nose, nasal congestion or itchy and watery eyes due to allergy to these grass pollens. ORALAIR may be prescribed for persons 5 to 65 years old whose doctor has confirmed are allergic to any of these grass pollens.
If any of these symptoms occur, stop taking ORALAIR and immediately seek medical care. For home administration of ORALAIR, your doctor should prescribe auto-injectable epinephrine for you to keep at home for treating a severe reaction, should one occur. Your doctor will train and instruct you on the proper use of auto-injectable epinephrine.
Please see Important Safety Information below. Please see full Prescribing Information, including Boxed Warning and Medication Guide.
ORALAIR can cause severe allergic reactions that may be life-threatening. Symptoms of allergic reactions to ORALAIR include:
If any of these symptoms occur, stop taking ORALAIR and immediately seek medical care. For home administration of ORALAIR, your doctor should prescribe auto-injectable epinephrine for you to keep at home for treating a severe reaction, should one occur. Your doctor will train and instruct you on the proper use of auto-injectable epinephrine.
Do not take ORALAIR if you or your child:
Stop taking ORALAIR and contact your doctor if you or your child has any mouth surgery procedures (such as tooth removal), develops any mouth infections, ulcers or cuts in the mouth or throat, or has heartburn, difficulty swallowing, pain with swallowing, or chest pain that does not go away or worsens.
In children and adults, the most commonly reported side effects were itching of the mouth, lips, tongue or throat. These side effects, by themselves, are not dangerous or life-threatening.
You may report side effects to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
Talk to your doctor before using ORALAIR while pregnant or breastfeeding.
Please see full Prescribing Information, including Boxed Warning and Medication Guide.
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ORALAIR® is a registered trademark of Stallergenes Greer or its affiliates.
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