AcipHex.com—Official AcipHex Website-Learn about heartburn and acid reflux disease

Join the ACIPHEX Program and receive money-saving offers

Just enter your information below and click SUBMIT. Or if you'd prefer, you can call 1-888-877-1201 and give us your information over the phone.

Terms of Information Use
Please be advised that the personal information you provide will be used to satisfy your request to receive a savings card and to fulfill any optional requests you have indicated. Eisai Inc. (“Eisai” or “we”), operates this website and our Privacy Policy will govern the collection, use, disclosure and retention of the information you provide here. Please do not submit any personal information unless you have read and agree with the terms of that Privacy Policy. Consistent with the Privacy Policy, we and our service providers may use the personal information you provide to contact you and send you communications, including about products or services that may interest you. In the event that you would like to opt out of receiving further communications, you can request that you be removed from the Eisai contact list at any time by clicking on the "Unsubscribe" link found at the bottom of all email communications from Eisai. By clicking “submit” below, you agree that you have read, understand, and agree to these conditions.

*Required Information.

*Are you 18 years of age or older?

YesNo

*Do you purchase your prescription medication through Medicare, Medicaid, TRICARE, or a similar federal or state prescription drug program?

YesNo

Void in Massachusetts. Void in California for patients with prescription coverage.

If you would like to join the ACIPHEX Program and receive a Monthly Savings Card, please read the information below and complete the required fields on the form. Or if you'd prefer, you can call
1-888-877-1201 and give us your information over the phone.

See card for details. Patients with prescription coverage and a co-pay of more than $20 are eligible to receive up to $55 off their ACIPHEX prescription, after a $20 out-of-pocket expense. Patients without prescription coverage may receive up to $55 off their ACIPHEX prescription.

Restrictions and Conditions of Use:

- Good toward the purchase of ACIPHEX prescriptions. No substitutions permitted.
- Not available to individuals insured by Medicare, Medicaid, TRICARE, or any similar state or federal healthcare programs.
- Monthly savings Card is void in Massachusetts, in California for patients with prescription coverage, and where prohibited by law.
- Benefit limited to one use per person for any 30-day period.
- Not valid through mail-order pharmacies.
- May not be accepted at all pharmacies.
- Not valid for ACIPHEX prescription reimbursed in full by any third-party payer.
- May not be combined with any other coupon, discount, prescription savings card, free trial, or other offer.
- Federal law prohibits the selling, purchasing, trading or counterfeiting of this Monthly Savings Card.
- Good only in the United States. Eisai Inc. reserves the right to rescind, revoke or amend this offer without notice at any time.
- Patients and pharmacies are responsible for disclosing to insurance carriers the redemption and value of the Card and complying with any other conditions imposed by insurance carriers or any third-party payers.
- The value of the Card is not contingent on any prior or future purchases. The Card is solely intended to provide up to $55 off any purchase of ACIPHEX. Use of the Card for any one purchase does not obligate the patient to make future purchases of ACIPHEX or any other product.

This card is not an insurance program.

No membership fees.

Offer expires 3/31/2020

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 more information about ACIPHEX^®, see Full Product Information.

ACIPHEX^® is a registered trademark used by Eisai Inc. under license from Eisai R&D Management Co., Ltd.
©2019 Eisai Inc.

All decisions regarding patient care must be made with a healthcare professional, considering the unique characteristics of the patient.

This information is intended for use by our customers, patients, healthcare professionals and interested parties in the United States only. Eisai Inc., recognizes that the Internet is a global communications medium; however, laws, regulatory requirements and medical practices for pharmaceutical products vary from country to country. The Prescribing Information included here is not appropriate for use outside the United States.

This site is published by Eisai Inc., which is solely responsible for its contents.

For more information about ACIPHEX^®, call 1-888-274-2378.

ACPX-US2006 04/2019