Free ACCU-CHEK Nano Meter BIN: 610524 | RxPCN: 1016 | Issuer: (80840) | Group: 40026479 | ID#: 069942159 Test Strip Prescription Discount BIN: 610524 | RxPCN: LOYALTY | Issuer: (80840) | Group: 40006478 | ID#: 069957436 With no coding, a brilliant backlit display and advanced accuracy—the ACCU-CHEK Nano meter is the perfect companion for your child’ s next big adventure. Plus, your camper can help protect and personalize his or her meter with an assortment of colorful silicone skins. Get one free at accu-chek.com/freeskin after your first test strip purchase! Small, bright and fits into your child’s life. Here’s how to take advantage of this offer: 1. Take this voucher to your doctor to get a prescription for an ACCU-CHEK Nano meter and ACCU-CHEK SmartView test strips. 2. Present the new prescription and this voucher to your pharmacist to redeem your FREE meter and enjoy a $0 co-pay on your child’s first test strip prescription. 1 Free ACCU-CHEK Nano Meter Offer: Receive a free ACCU-CHEK Nano meter with this voucher and a valid prescription for an ACCU-CHEK Nano meter. It is not appropriate to seek payment from Medicare, Medicare Advantage, Medicaid, Medigap, VA, DOD, TriCare, or any other government healthcare program or private payers for free products. Limit one meter per person. 2 ACCU-CHEK SmartView Test Strip Prescription Discount Offer: Receive a discount of $65 (up to the amount of your co-pay) off the strip purchase after primary insurance payment with a valid prescription for ACCU-CHEK SmartView test strips. If you pay cash, you will receive a discount up to $55 for a 100-count strip purchase or $35 for a 50-count strip purchase. Eligibility: You are not eligible to receive this discount if your prescriptions are paid by any state or federally funded program, including but not limited to Medicare, Medicare Advantage, Medicaid, Medigap, VA, DOD, or TriCare, or if you live in Massachusetts (except for cash payers) or where otherwise prohibited by law. Limit one strip purchase per person. Limitations: Valid at participating pharmacies only. By using this voucher, you certify that you understand and agree to comply with all program rules, regulations, and terms and conditions. Roche has the right to rescind or amend this offer without notice. Pharmacists: • Each offer must be submitted as a separate transaction. Each claim has unique RxBIN, RxPCN and RxGrp values on the voucher. Free Meter Transaction: Input voucher information for the free ACCU-CHEK Nano meter as primary coverage. Strip Discount Transaction: If primary coverage exists, input voucher information for strip discount as secondary coverage and transmit using the COB segment of the NCPDP transaction. Applicable discounts will be displayed in the transaction response. • Acceptance of this co-pay voucher and your submission of claims for this program are subject to the LoyaltyScript ® program. Terms and conditions posted at www.mckesson.com/mprstnc. • By using this voucher, you certify that you have not submitted and will not submit a claim for reimbursement under any federally funded program, including but not limited to Medicare, Medicaid, Medigap, VA, DOD or TriCare. Voucher not valid in Massachusetts (except for cash payers) or where otherwise prohibited by law. Pharmacist Helpline: 1-800-657-7613 (8:00 am-8:00 pm, EST, Monday-Friday). ACCU-CHEK, ACCU-CHEK NANO SMARTVIEW, ACCU-CHEK NANO and ACCU-CHEK SMARTVIEW are trademarks of Roche. All other product names and trademarks are the property of their respective owners. © 2013 Roche. 346-52120-0413 Physician: Affix this sticker to your prescription pad to prescribe an ACCU-CHEK Nano meter and ACCU-CHEK SmartView test strips for your patient.