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. Card not available to individuals enrolled in federally subsidized healthcare programs that cover prescription drugs, including Medicare, Medicaid, TRICARE, or any similar federal or state programs. Monthly Savings Card is void in Massachusetts, in California for patients with prescription coverage, and where prohibited by law. 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 third-party payers. Other restrictions apply. Please see complete Patient Instructions and Restrictions and Conditions of Use that accompany the Monthly Savings Card.