TERMS AND CONDITIONS
In order to redeem this offer you must have a valid prescription for a Dexcom CGM G6. Present this card to the pharmacist for an instant rebate of up to $60 off one receiver and one transmitter. Patients may also be eligible for an instant rebate of up to $20 off on one sensor 3-pack if initial copay exceeds $60. Maximum benefit for receiver, transmitter, and sensor kit is $140. This offer may not be redeemed for cash. By using this offer, you are certifying that you meet the eligibility criteria and will comply with the terms and conditions described in the Eligibility and Restrictions section below. Patients with questions about the Dexcom Co-pay offer should call 1-844-436-2270.
Pharmacist Instructions: Submit claim to primary Third Party first, then submit balance due to Therapy First Plus as a Secondary Payer COB with patient responsibility amount and valid Other Coverage Code (OCC08). When you apply this offer, you are certifying that you have not submitted a claim for reimbursement under any federal, state, or other governmental programs for this prescription. Participation in this program must comply with all applicable laws and regulations as a pharmacy provider. By participating in this program, you are certifying that you will comply with the terms and conditions described in the Eligibility and Restrictions section below. For any questions regarding Therapy First Plus processing, please call the Help Desk at 1-800-422-5604.
Eligibility and Restrictions: Valid for commercially insured patients with pharmacy coverage for Dexcom products, age 2 years and older only. Limit 1 offer per purchase. This offer is not valid in Massachusetts. According to federal and state laws, this offer is not valid for prescriptions reimbursed under Medicaid, a Medicare drug benefit plan, Tricare or other federal or state health programs (such as medical assistance programs). If the patient is eligible for drug benefits under any such program, the patient cannot use this offer. By using this offer, the patient certifies that he or she will comply with any terms of his or her health insurance contract requiring notification to his or her payer of the existence and/or value of this offer. It is illegal to (or offer to) sell, purchase, or trade this offer. This promotion is not transferable and cannot be combined with any other programs, offers or discounts. Not valid if reproduced. Void where prohibited by law. Program managed by ConnectiveRx on behalf of Dexcom. The parties reserve the right to rescind, revoke or amend this offer without notice at any time.
This card must be activated before fill and presented at time of fill for instant savings. Must be activated or used by December 31, 2020.
Patients with questions about the Dexcom Co-pay offer should call 1-844-436-2270.
BRIEF SAFETY STATEMENT
Indications for Use
The Dexcom G6 Continuous Glucose Monitoring System (G6) is an autonomous, real-time, continuous glucose monitoring device indicated for the management of diabetes in persons age 2 years and older. The glucose measurements are intended to replace fingerstick blood glucose testing for diabetes treatment decisions and behavioral modifications. The G6 can communicate wirelessly to and from other interoperable devices.
Do not wear your G6 (sensor, transmitter, receiver, or smart device) for magnetic resonance imaging (MRI), computed tomography (CT) scan, or high-frequency electrical heat (diathermy) treatment. It is MR Unsafe.
Failure to use the Dexcom G6 Continuous Glucose Monitoring System (G6) and its components according to the instructions for use provided with your device and available at https://www.dexcom.com/safety-information and to properly consider all indications, contraindications, warnings, precautions, and cautions in those instructions for use may result in you missing a severe hypoglycemia (low blood glucose) or hyperglycemia (high blood glucose) occurrence and/or making a treatment decision that may result in injury. If your glucose alerts and readings from the G6 do not match symptoms or expectations or you’re taking over the recommended maximum dosage amount of 1000mg of acetaminophen every 6 hours, use a blood glucose meter to make diabetes treatment decisions. Seek medical advice and attention when appropriate, including for any medical emergency.