Welcome,

Enter the following information to access your copay program

COPAY ACTIVATED

To pay for your medication follow these two steps

Step 1

Present CoPay details to pharmacy

Step 2

Present payment card details to pay remaining balance

CVV XXX EXP XX/XX XXXX XXXX XXXX XXXX (80840) MEMBERID: 50777421 RxGRP: 1016 RxPCN: 610524 RxBIN: COPAY
For issues call: