SAVING ON AIRSUPRA

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PAY AS LITTLE AS $0* FOR AIRSUPRA WITH THE SUPRA SAVINGS CARD

Can be used for multiple inhalers at once.†

Eligible people pay as little as $0* per month.

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AIRSUPRA Saving Card

*Terms and Conditions apply. Government restrictions exclude people enrolled in federal government insurance programs from co-pay support. If you don’t meet the terms and conditions and cannot afford your medication, you may be eligible for AZ&Me. If you have questions about this program or your eligibility, please contact 1-866-480-0030.

†Pending your insurance requirements.

AIRSUPRA Saving Card

Register to receive your SUPRA Savings Card and other updates

All fields with an asterisk (*) are required. Your SUPRA Savings Card registration will be complete after submitting this form.

 

By providing your phone number, you will be signing up for My ASP updates. Text STOP to opt out. Text HELP for help. Message frequency may vary. For more information, visit www.azprivacynotice.com. See Terms and Conditions here. Message and data rates may apply.

By completing this registration, you are confirming that you are at least 18 years old, are a resident of the US, and would like to receive information in the future about AIRSUPRA and related health information, including support related to your condition and treatment information.

AstraZeneca respects your personal health information. The information you provide may be used to send you health-related materials and to develop products, services, and programs. AstraZeneca, or third parties working on our behalf, will not sell or rent personal health information. If, in the future, you no longer want to receive health-related materials, call 1-800-236-9933. Please visit www.azprivacynotice.com to review our Privacy Notice.

  • *Terms and conditions. Government restrictions exclude people enrolled in federal government insurance programs from co-pay support. If you don’t meet the terms and conditions and cannot afford your medication, you may be eligible for AZ&Me. If you have questions about this program or your eligibility, please contact 1-866-480-0030.

  • †Pending your insurance requirements.

AIRSUPRA Saving Card

Download the SUPRA Savings Card and start saving today

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  • *Subject to eligibility rules and maximum savings limits; restrictions may apply.

  • †Pending your insurance requirements.

ELIGIBILITY AND TERMS OF USE

ELIGIBILITY: You may be eligible for this offer if you are insured by commercial insurance and your insurance does not cover the full cost of your prescription. Patients who are enrolled in a state- or federally funded prescription insurance program are not eligible for this offer. This includes patients enrolled in Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DOD) programs, or TriCare, and patients who are Medicare eligible and enrolled in an employer-sponsored group waiver health plan or government-subsidized prescription drug benefit program for retirees. If you are enrolled in a state- or federally funded prescription insurance program, you may not use this savings card even if you elect to be processed as an uninsured (cash-paying) patient. This offer is not insurance and is restricted to residents of the United States or a United States Territory (Puerto Rico, Guam, U.S. Virgin Islands, Northern Mariana Islands, American Samoa).

TERMS OF USE: Eligible commercially insured/covered patients with no restrictions (step-edit, prior authorization, or NDC block) and a valid prescription for AIRSUPRA® (albuterol/budesonide) Inhalation Aerosol who present this savings card at participating pharmacies will pay as low as $0 for each inhaler, subject to a maximum savings limit; patient out-of-pocket expenses may vary. If you are insured and your insurance does not cover or has a managed care restriction on your prescription (step-edit, prior authorization, or NDC block), you will pay as low as $15 for each inhaler, subject to a maximum savings limit. Other restrictions may apply. Patient is responsible for applicable taxes, if any. Non-transferable, limited to one per person, cannot be combined with any other offer. Void where prohibited by law, taxed, or restricted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer. AstraZeneca reserves the right to rescind, revoke, or amend this offer, eligibility, and terms of use at any time without notice. This offer is not conditioned on any past, present, or future purchase, including refills. Offer must be presented along with a valid prescription at the time of purchase. For additional details about this offer, please visit www.AIRSUPRAsavings.com. If you have any questions regarding this offer, please call 1-866-480-0030.

ADDITIONAL PROGRAM TERMS AND CONDITIONS: At its sole discretion and with or without notice, AstraZeneca may reduce, eliminate, or otherwise modify the card for any reason, including but not limited to if your commercial drug insurance plan imposes additional requirements which limit or prevent you from receiving coverage for your inhaler, only allow partial coverage for your inhaler, remove coverage for your inhaler and require you to utilize the card, do not provide a material level of financial assistance for the cost of your inhaler, or do not apply program payments to satisfy your co-payment, deductible, or coinsurance for your inhaler. You must meet the eligibility criteria, terms and conditions every time you use the card.

BY USING THIS CARD, YOU AND YOUR PHARMACIST UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

Pharmacist Instructions for a Patient With an Eligible Third-Party Payer:
For Insured/Covered Patients: Submit the claim to the primary Third-Party Payer first, then submit the balance due to Pharmacy Data Management Inc as a Secondary Payer COB with patient responsibility amount and a valid Other Coverage Code of 8. This will reduce the eligible patient’s out-of-pocket costs to as low as $0 for each inhaler, subject to a maximum savings limit; patient out-of-pocket expenses may vary. Reimbursement will be received from Pharmacy Data Management Inc.

Pharmacist Instructions for Insured/Not Covered Patients: Submit the claim to the primary Third-Party Payer first; if the primary claim submission shows a managed care restriction (step-edit, prior authorization, or NDC block), continue the claim adjudication process and submit the balance due to Pharmacy Data Management Inc as a Secondary Payer COB with patient responsibility amount and a valid Other Coverage Code of 3. This will reduce eligible patient’s out-of-pocket costs to as low as $15 for each inhaler, subject to a maximum savings limit. Reimbursement will be received from Pharmacy Data Management Inc.

For any questions regarding Pharmacy Data Management Inc online processing, please call the Help Desk at 1-800-800-7364.

If you don’t meet the above terms and conditions and cannot afford your medication, you may be eligible for our patient assistance program AZ&Me.

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IMPORTANT SAFETY INFORMATION

  • Do not use AIRSUPRA if you are allergic to albuterol, budesonide, or any of the ingredients in AIRSUPRA
  • Before using AIRSUPRA, tell your healthcare provider about all your medical conditions and about all the medicines you take
  • A dose of AIRSUPRA is 2 inhalations (puffs) as needed. Use AIRSUPRA exactly as your healthcare provider tells you to use it. Do not use AIRSUPRA more than 12 puffs (which equals 6 doses) within a 24-hour period
  • AIRSUPRA is not to be used as a maintenance treatment for asthma. If you are currently taking medicine long-term to maintain control of asthma symptoms, you should continue to take that medicine as directed by your healthcare provider
  • Do not change or stop other inhaled medicines or asthma medicines (oral or inhaled) without first talking to your healthcare provider
  • Call your healthcare provider or get emergency medical care right away if your breathing problems get worse, you need to use AIRSUPRA more often than usual, or AIRSUPRA does not work as well to relieve your asthma
  • AIRSUPRA can cause serious side effects, including:
    • worsening trouble breathing, coughing, and wheezing (paradoxical bronchospasm). If this happens, stop using AIRSUPRA and call your healthcare provider or get emergency medical care right away. This is more likely to happen with your first use of a new canister of medicine
    • heart problems, including faster heart rate and higher blood pressure
    • possible death in people who use too much AIRSUPRA
    • serious allergic reactions. Tell your healthcare provider or get emergency medical care right away if you have a skin rash, redness, or swelling; severe itching; swelling of the face, mouth, or tongue; trouble breathing or swallowing; or chest pain
    • changes in laboratory blood levels. Low levels of potassium (hypokalemia) may cause abnormal heart rhythms
    • weakened immune system and increased chance of getting infections
    • fungal infection in your mouth and throat (thrush). This is a common side effect. Rinse your mouth with water, if available, without swallowing after using AIRSUPRA to help reduce your chance of getting thrush
    • reduced adrenal function (adrenal insufficiency). This can happen when you start taking a medicine containing an inhaled corticosteroid (such as AIRSUPRA)
    • bone thinning or weakness (osteoporosis)
    • eye problems, including glaucoma and cataracts. Your healthcare provider may suggest having regular eye exams while using AIRSUPRA. Discuss any eye problems with your healthcare provider
  • Common side effects include headache, cough, and hoarseness. These are not all the side effects of AIRSUPRA. For more information, ask your healthcare provider or pharmacist

APPROVED USE

AIRSUPRA combines 2 medicines to be used as needed as a rescue inhaler in people 18 years of age and older to:

  • treat or prevent symptoms of asthma
  • help prevent sudden severe breathing problems (asthma attacks)

Please see full Prescribing Information and Patient Information and discuss with your doctor.

You may report side effects related to AstraZeneca products.link

IMPORTANT SAFETY INFORMATION

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