Dilantin

CASH OPTION PROGRAM TERMS AND CONDITIONS
Valid only for eligible cash patients and insured patients without coverage for DILANTIN® (extended phenytoin sodium capsules) with a valid prescription for DILANTIN. The DILANTIN Cash Option Program does not process insurance claims and cannot be combined with insurance. Patients may not seek reimbursement for DILANTIN purchased through this cash option from any government healthcare program or apply the DILANTIN Cash Option Program payments to any deductible, co-pay, or to any other out-of-pocket spending calculations for any insurer or third-party payer, including any government healthcare program, such as Medicare Part D true out-of-pocket (TrOOP) costs. Participating Medicare Part D patients agree to purchase all prescriptions for DILANTIN for the calendar year through the Cash Option Program and may not seek coverage for DILANTIN from any government healthcare program at any time during the calendar year, even if their benefits change. The DILANTIN Cash Option Program is not health insurance and may not be combined with any other offer, including any third-party rebate, coupon, other cash discount card, or free trial. This Cash Option is not transferable and is not redeemable for cash. The DILANTIN Cash Option Program is redeemable only by eligible patients or patient guardians 18 years of age or over and who are residents of the United States. The DILANTIN Cash Option Program may be filled through a retail pharmacy. Patients are responsible for reporting use of the DILANTIN Cash Option Program to any private insurer, health plan, government healthcare program, or third-party payer. When using this DILANTIN Cash Option Program, the patient certifies that he/she understands the rules, requirements, and these Terms and Conditions every time the patient uses this DILANTIN Cash Option Program. No other purchase is necessary. Viatris reserves the right to rescind, revoke, or amend this offer without notice, at any time, at its sole discretion. For further information or assistance with the DILANTIN Cash Option Program, please call 1-833-944-5687.
US-MUL-2025-00015

Sponsored by Viatris Inc.