Save on ACIPHEX with a Monthly Savings Card

Join the ACIPHEX Program and receive money-saving offers that may help manage your acid reflux disease symptoms.
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?

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

Monthly Savings Card is void in Massachusetts.

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. 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.