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Bring this to your pharmacy along with your prescription You may save each month on your prescription† ELIGIBLE PATIENTS USING INSURANCE may pay no more than each month† ELIGIBLE PATIENTS USING INSURANCE may pay no more than each month† 25 $ (New patients allowed 2 fills in the first month) BILL PRIMARY INSURANCE FIRST RxBIN: RxGrp: RxID: ELIGIBLE PATIENTS NOT USING INSURANCE 601341 RxPCN: OHCP OH8301081 136171547941 Suf: may save more than each month‡ 170 170 $ $ month‡ each may save more than 25 $ III 01 See full offer details. Not valid for prescriptions paid for by government-funded health insurance. (New patients allowed 2 fills in the first month) ELIGIBLE PATIENTS NOT USING INSURANCE may save more than each month‡ 170 $ government-funded health insurance. Not valid for prescriptions paid for by See paid full offerby details. You are not eligible if your prescriptions are any state NOT USINGfunded INSURANCE or federally health insurance, including, but not limited Suf: ELIGIBLE PATIENTS to Medicare, Medicaid, Medigap, VA, DOD, TriCare, or where RxID: prohibited by law. RxGrp: 25 $ 2 fills in the first month) RxPCN: (New patients allowed RxBIN: For more information, visit suboxone.com month † each may pay no more than BILL PRIMARY INSURANCE FIRST F or eligible patients using insurance, this card covers up to $75 each month on your USING INSURANCE III copay. Limit 1 fill per month. For eligible new patients using insurance, this card allows for 2 fills the first monthELIGIBLE for a totalPATIENTS copay savings of up to $75 off. Patients who have used a savings card for SUBOXONE® (buprenorphine and naloxone) Sublingual Film (CIII) in the past 12 months are not eligible for the additional new patient offer. ‡ For eligible patients not using insurance, this card covers up to $0.96 off per individual 2 mg Film (up to 90 Films or $86 per month), $1.92 off per individual 4 mg and 8 mg Film (up to 90 Films or $173 per month), and up to $3.84 off per individual 12 mg Film (up to 60 Films or $230 per month). Maximum of 4 redemptions per month (7 film minimum per redemption). Patient Instructions: You must present the savings card to your pharmacist, along with your insurance card (if applicable) and a valid prescription for SUBOXONE Film to receive your savings off of each SUBOXONE Film prescription. When you use this card, you are certifying that you understand the program rules, regulations, and terms and conditions. You may take advantage of only one savings program from Indivior Inc. at any one time. By using this card, you certify that you will not seek reimbursement for the value received from this card from any third-party payers, including a flexible spending account or healthcare savings account. Use of this offer must be consistent with the Full Prescribing Information. Patients enrolled in any SUBOXONE product patient assistance program are not eligible to receive this offer. Void where prohibited by law, taxed or otherwise restricted. The selling, purchasing, trading, or counterfeiting of savings cards is prohibited by law. Offer valid only at participating pharmacies in the US. Indivior Inc. reserves the right to rescind, revoke, or amend this offer without notice. Your offer has its own unique ID number. You can’t transfer it or provide a copy to another person; only you can use it. If you lose your offer before the first time you use it, simply print or download a new copy at suboxone.com and bring it to the pharmacy. Patients are encouraged to call OPUS Health at 1-877-678-7493 with any questions. Pharmacist Instructions: When you use this card, you are certifying that you have not submitted and will not submit a claim for reimbursement under any federal, state, or other government healthcare programs for this prescription. This offer must be accompanied by a valid prescription for SUBOXONE Film. Use of this offer must be consistent with the Full Prescribing Information. BILL PRIMARY INSURANCE FIRST. Please submit the copay authorized by the patient’s primary insurance as a secondary transaction to OPUS Health. For uninsured patients, submit the claim to OPUS Health only. Pharmacists with questions, please call OPUS Health at 1-800-364-4767. This card is the property of Indivior Inc. and OPUS Health and must be returned upon request. Both parties retain the right to rescind, revoke, or amend this program without notice. Card is limited to one per person and is not transferable. This card is not health insurance. Not valid if reproduced. Product is dispensed pursuant to terms of card. † Please see Important Safety Information on next page, and Full Prescribing Information and Medication Guide for SUBOXONE Film at suboxone.com. Important Safety Information INDICATION SUBOXONE (buprenorphine and naloxone) Sublingual Film (CIII) is a prescription medicine indicated for treatment of opioid dependence and should be used as part of a complete treatment plan to include counseling and psychosocial support. Treatment should be initiated under the direction of physicians qualified under the Drug Addiction Treatment Act. ® IMPORTANT SAFETY INFORMATION Do not take SUBOXONE Film if you are allergic to buprenorphine or naloxone as serious negative effects, including anaphylactic shock, have been reported. SUBOXONE Film can be abused in a manner similar to other opioids, legal or illicit. SUBOXONE Film contains buprenorphine, an opioid that can cause physical dependence with chronic use. Physical dependence is not the same as addiction. Your doctor can tell you more about the difference between physical dependence and drug addiction. Do not stop taking SUBOXONE Film suddenly without talking to your doctor. You could become sick with uncomfortable withdrawal symptoms because your body has become used to this medicine. SUBOXONE Film can cause serious life-threatening breathing problems, overdose and death, particularly when taken by the intravenous (IV) route in combination with benzodiazepines or other medications that act on the nervous system (ie, sedatives, tranquilizers, or alcohol). It is extremely dangerous to take nonprescribed benzodiazepines or other medications that act on the nervous system while taking SUBOXONE Film. You should not drink alcohol while taking SUBOXONE Film, as this can lead to loss of consciousness or even death. Death has been reported in those who are not opioid dependent. Keep SUBOXONE Film out of the sight and reach of children. Accidental or deliberate ingestion of SUBOXONE Film by a child can cause severe breathing problems and death. Do not take SUBOXONE Film before the effects of other opioids (eg, heroin, hydrocodone, methadone, morphine, oxycodone) have subsided as you may experience withdrawal symptoms. Injecting SUBOXONE may cause serious withdrawal symptoms such as pain, cramps, vomiting, diarrhea, anxiety, sleep problems, and cravings. Before taking SUBOXONE Film, tell your doctor if you are pregnant or plan to become pregnant. If you are pregnant or become pregnant while taking SUBOXONE Film, alert your doctor immediately and you should report it using the contact information provided below.* Neonatal withdrawal has been reported following the use of buprenorphine by the mother during pregnancy. Before taking SUBOXONE Film, talk to your doctor if you are breastfeeding or plan to breastfeed your baby. SUBOXONE can pass into your breast milk. You and your doctor should consider the development and health benefits of breastfeeding along with your clinical need for SUBOXONE Film and should also consider any potential adverse effects on the breastfed child from the drug or from the underlying maternal condition. Do not drive, operate heavy machinery, or perform any other dangerous activities until you know how SUBOXONE Film affects you. Buprenorphine in SUBOXONE Film can cause drowsiness and slow reaction times during dose-adjustment periods. Common side effects of SUBOXONE Film include nausea, vomiting, drug withdrawal syndrome, headache, sweating, numb mouth, constipation, painful tongue, redness of the mouth, intoxication (feeling lightheaded or drunk), disturbance in attention, irregular heartbeat, decrease in sleep, blurred vision, back pain, fainting, dizziness, and sleepiness. Your doctor may monitor liver function before and during treatment. This is not a complete list of potential adverse events associated with SUBOXONE Film. Please see Full Prescribing Information for a complete list. SUBOXONE Film is not recommended in patients with severe hepatic impairment and may not be appropriate for patients with moderate hepatic impairment. However, SUBOXONE Film may be used with caution for maintenance treatment in patients with moderate hepatic impairment who have initiated treatment on a buprenorphine product without naloxone. o report negative side effects associated with taking T SUBOXONE Film, please call 1-877-782-6966. 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. SUBOXONE® is a registered trademark of Indivior UK Limited Manufactured for Indivior Inc., Richmond, VA 23235 by MonoSol Rx LLC, Warren, NJ 07059 Copyright © 2015 Indivior Inc. SBF-UM-P-1218-1510 P1218151 0 For more information about SUBOXONE Film, SUBOXONE® (buprenorphine and naloxone) Sublingual Tablets (CIII), or SUBUTEX® (buprenorphine) Sublingual Tablets (CIII), please see the respective Full Prescribing Information and Medication Guide at www.IndiviorREMS.com