Patient Instructions: If prescription is covered by insurance, you may need to notify the insurance carrier of

redemption of this copay card. This offer is not valid for prescriptions covered by or submitted for reimbursement under
Medicaid, Medicare, VA, DOD, TRICARE, or similar federal or state programs including any state pharmaceutical
assistance program. This program is not valid where prohibited by law. By redeeming this coupon, you are certifying
that (1) you are not a beneficiary of any government funded programs as noted above; (2) should you begin receiving

10*
PER PRESCRIPTION prescription benefits from any government funded program, you will withdraw from this savings program; and (3) you
$ Subject to Maximum Savings (See Below)
acknowledge and understand that adherence to the terms and conditions of this offer, as noted above and posted at
www.mckesson.com/mprstnc, is necessary to ensure compliance with laws pertaining to Federal Healthcare Programs.
For questions regarding your eligibility or benefits, or if you wish to discontinue your participation, call the Sanofi US
Corporate Loyalty Card program at 866-390-5622 (8:00 AM-8:00 PM EST, Monday-Friday).

RxBIN: 610524 Pharmacist: When you process this card, you are certifying that you have read, understood, and are in compliance
with the terms and conditions pertaining to this program. You are further certifying that you have not submitted and will
RxPCN: Loyalty not submit a claim for reimbursement under Medicaid, Medicare, VA, DOD, TRICARE, or similar federal or state
programs including any state pharmaceutical assistance program for this prescription.
OPEN FOR
RxGRP: 50777058 SAVINGS AND • Submit transaction to McKesson Specialty Arizona, Inc. using BIN #610524.
TERMS OF USE • If primary coverage exists, input card information as secondary coverage and transmit using the COB segment of
ISSUER: (80840) INFORMATION the NCPDP transaction. Applicable discounts will be displayed in the transaction response.
• Acceptance of this card and your submission of claims for the Sanofi US Corporate Loyalty Card Program are
ID: 335375429 subject to the LoyaltyScript® program Terms and Conditions established by McKesson Specialty Arizona, Inc. By
*Savings may vary. See below and to the right for eligibility and terms of use information. accepting this card, you agree to the LoyaltyScript® program Terms and Conditions posted at
www.mckesson.com/mprstnc.
• LoyaltyScript® is not an insurance card.
• For questions regarding setup, claim transmission, patient eligibility or other issues,
call the LoyaltyScript® for Sanofi US Corporate Loyalty Card Program at 866-390-5622
(8:00 AM-8:00 PM EST, Monday-Friday).

© 2002-2017 sanofi-aventis U.S. LLC. All rights reserved. US.GLT.16.10.152

THIS CARD CAN BE USED IN ANY RETAIL PHARMACY.

SAVINGS OFFER FOR ELIGIBLE* PATIENTS WITH A VALID PRESCRIPTION FOR:
• Maximum of 3 boxes of Toujeo SoloStar® per prescription.
• If you are enrolled in a commercial insurance plan:
Maximum savings of up to $500 per box.
• Not enrolled in a commercial insurance plan: Maximum
savings of up to $200 per box.
• Maximum of 3 boxes of Lantus SoloStar® or 3 vials of
Lantus® per prescription.
• If you are enrolled in a commercial insurance plan: Maximum savings of up to $500 per box of
Lantus Solostar® or vial of Lantus®.
• Not enrolled in a commercial insurance plan: Maximum savings of up to $100 per box of Lantus
Solostar® or vial of Lantus®.
• If you are enrolled in a commercial insurance plan or paying cash: Maximum savings of $100
off per monthly prescription of Apidra SoloStar® or vial of Apidra®.
*See terms of use on the right. Sanofi US reserves the right to rescind, revoke, or amend any and all
offers without notice.
FOR MAIL ORDER PHARMACY, ACTIVATE YOUR CARD THEN
FOLLOW THESE STEPS:
1. Call your mail order pharmacy to see if they accept the Sanofi Rx Savings Card.
2. If your mail order pharmacy DOES accept the Sanofi Rx Savings Card:
Mail a copy of your card to the pharmacy or provide them with the RxBIN, RxGRP,
RxPCN, and your Sanofi Rx Savings Card ID number on the front of your card to be
applied to your prescription.
3. If your mail order pharmacy DOES NOT accept the Sanofi Rx Savings Card, you
can go to your local pharmacy and use the card immediately; or
Fill the prescription at your mail order pharmacy and apply for a rebate as follows:
a) Go to www.patientrebateoneline.com or call 1-866-390-5622 to request a Direct
Member Reimbursement (DMR) form.
b) Return the completed DMR form, along with your pharmacy receipt, to the
address on the form.
c) If eligible, you should receive a rebate check within 2-4 weeks of eligibility
verification.