Download $170 $25 170 25

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
136124503671
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