Through the UCERIS® Instant Savings Program, eligible patients with commercial insurance may pay no more than $25 copay for each UCERIS prescription (maximum benefits apply)*. Enroll Now in the UCERIS Instant Savings Program *Card ID: *First name: *Last name: *Address 1: Address 2: *City: *State: Loading...*Zip: *Email: *Confirm Email: *Phone Number: *DOB: I certify that the patient who will use this savings card is an eligible commercially-insured patient.I certify that the patient who will use this savings card is not eligible for reimbursement of prescriptions (in whole or in part) under any federal, state or other governmental programs, including, but not limited to, Medicare (including Medicare Advantage and Part A, B and D plans), Medicaid, TRICARE, Veterans Administration or Department of Defense health coverage, CHAMPUS, the Puerto Rico Government Health Insurance Plan or any other federal or state healthcare programs.Yes! I am also interested in receiving additional communications (health tips, wellness tools, coupons, other discounts, educational materials, product information, etc) from Salix Pharmaceuticals or its affiliates*Captcha Submit Eligibility Criteria, Terms and Conditions This offer is only valid for patients 18 years of age or older with commercial insurance, including commercially insured patients without coverage for UCERIS. Patients without commercial insurance are not eligible. This offer is not valid for any person eligible for reimbursement of prescriptions, in whole or in part, by any federal, state, or other governmental programs, including, but not limited to, Medicare (including Medicare Advantage and Part A, B, and D plans), Medicaid, TRICARE, Veterans Administration or Department of Defense health coverage, CHAMPUS, the Puerto Rico Government Health Insurance Plan, or any other federal or state health care programs. Eligible insured patients with coverage for UCERIS must pay the first $25 of their co-pay and eligible insured patients without coverage for UCERIS must pay the first $25 of out of pocket expense and then Salix Pharmaceuticals will pay the remaining co-pay/out of pocket expense up to the maximum amount of $600 per fill. Maximum benefits apply. Maximum benefits are as follows: UCERIS tablets: $600/prescription, for up to one use per month for a calendar year; UCERIS rectal foam: $600/ prescription, for up to 8 uses in a calendar year. Offer expires December 31, 2016 Patient is responsible for all additional costs and expenses after the maximum limit is reached You agree not to seek reimbursement for all or any part of the benefit received through this offer and are responsible for making any required reports of your use of this offer to any insurer, health plan, or other third party who pays any part of the prescription filled This savings program cannot be combined with any other coupon, certificate, voucher, or similar offer Offer good only in the USA at participating retail pharmacies and cannot be redeemed at government-subsidized clinics Participation in this program must comply with all applicable laws and contractual or other obligations as a pharmacy provider This card has no cash value and no other purchase is necessary This is not health insurance Participating patients and pharmacists understand and agree to comply with the Terms and Conditions of this offer as set forth herein Any step-edits or prior authorizations required by the insurance plan still apply Salix Pharmaceuticals reserves the right to modify or cancel this program at any time The UCERIS Instant Savings Card Savings card must be activated prior to use by visiting www.uceris.com or by calling 855-558-1669 Participating patients must present their activated UCERIS Instant Savings Card for every eligible prescription fill or refill Mail Order The UCERIS Instant Savings Card may be used for mail-order prescriptions Reimbursement: Benefits that could not be processed through mail order may qualify for reimbursement. Please visit www.patientrebateonline.com for instructions on how to mail in your prescription receipt for reimbursement. *Restrictions apply. Please see "Eligibility Criteria, Terms and Conditions" above.