Auvi‑Q™ (epinephrine injection, USP) is indicated in the emergency treatment of allergic reactions (Type I) including anaphylaxis to allergens, idiopathic and exercise-induced anaphylaxis. Auvi‑Q is intended for individuals with a history of anaphylaxis or who are at risk for anaphylactic reactions.
Auvi‑Q should ONLY be injected into the anterolateral aspect of the thigh. DO NOT INJECT INTO BUTTOCK OR INTRAVENOUSLY.
Epinephrine should be administered with caution to patients with certain heart diseases, and in patients who are on medications that may sensitize the heart to arrhythmias, because it may precipitate or aggravate angina pectoris and produce ventricular arrhythmias. Arrhythmias, including fatal ventricular fibrillation, have been reported in patients with underlying cardiac disease or taking cardiac glycosides or diuretics. Patients with certain medical conditions or who take certain medications for allergies, depression, thyroid disorders, diabetes, and hypertension, may be at greater risk for adverse reactions. Adverse reactions to epinephrine include anxiety, apprehensiveness, restlessness, tremor, weakness, dizziness, sweating, palpitations, pallor, nausea and vomiting, headache, and/or respiratory difficulties.
Auvi‑Q is intended for immediate self-administration as emergency supportive therapy only and is not a substitute for immediate medical or hospital care.
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.
Please see full Prescribing Information.
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Eligible Patients: Maximum benefit of $100 per two‑pack of Auvi‑Q, up to a maximum of three two‑packs per prescription. This offer can be used an unlimited number of times until 12/31/2013. Prescriber ID# required on prescription. This offer is not valid for prescriptions covered by or submitted for reimbursement under Medicaid, Medicare, or similar federal or state programs including any state medical pharmaceutical assistance program.
Patient Instructions: If prescription is covered by insurance, you may need to notify the insurance carrier of redemption of this copay card. Patient not eligible if prescriptions are paid in part or full by any state or federally funded programs, including, but not limited to, Medicare or Medicaid. In order to redeem this card you must have a valid prescription for Auvi‑Q. Follow the dosage instructions given by the doctor. This card may not be redeemed for cash. Only one card per patient. For questions regarding your eligibility or benefits or if you wish to discontinue your participation, please call 1‑855‑226‑3941.
Pharmacist Instructions for a Patient with an Eligible Third Party: Submit the claim to the primary Third‑Party Payer first, then submit the balance due to Therapy First Plus as a Secondary Payer coordination of benefits with patient responsibility amount and a valid Other Coverage Code (e.g., 8). The Patient pay amount submitted will be reduced by up to $100 per two‑pack. Reimbursement will be received from Therapy First Plus.
Pharmacist Instructions for a Cash‑Paying Patient: Submit the claim to Therapy First Plus. A valid Other Coverage Code (e.g., 1) is required. The Patient pay amount submitted will be reduced by up to $100 per two‑pack. Reimbursement will be received from Therapy First Plus.
Valid Other Coverage Code required. For any questions regarding Therapy First Plus online processing, please call the Help Desk at 1‑800‑422‑5604.
The card is not transferable and the amount of the rebate cannot exceed the patient's out‑of‑pocket expenses. Program expires 12/31/2013. Program managed by PSKW, LLC on behalf of sanofi‑aventis U.S. LLC. Product dispensed pursuant to program rules and federal and state laws. The parties reserve the right to amend or end this program at any time without notice.
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