Thank you for visiting the Co-Pay Card Activation Site.
Please be sure to have your Co-Pay Card on hand as you will need the identification number printed on the front of the card to complete your activation. If you have any questions please contact Customer Service at: 1-866-923-1953.
To see if you are eligible, please answer the following questions:
Are you currently a resident of the United States or Puerto Rico?
Are you a patient or caregiver who is 18 years of age or older?
Is your prescription eligible to be paid in part or full by any government funded program, including but not limited to Medicare, Medicare Part D, Medicaid, Medigap, VA, CHAMPUS, DOD, TriCare or any State Patient or Pharmaceutical Assistance Program?
Please enter the identification number printed on the front of your card
  • We're sorry, you must be a resident of the U.S. or Puerto Rico to qualify.
  • We're sorry, you must be 18 or over to activate your Co-Pay Card.
  • We're sorry, individuals covered by any state or federally funded program do not qualify for the Co-Pay Card.
  • We're sorry, please enter your Co-Pay Card ID.
This site is intended for use by United States residents aged 18 or older.
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