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Advocates cannot respond to any requests for medical advice. Please call your physician or specialty pharmacy, as they would provide advice most appropriate to your situation. If this is a medical emergency, please call emergency services (911).

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Terms and Conditions

Patient instructions

  1. By using this coupon, you are certifying that:
  2. 1) You meet the eligibility criteria and have read and agree to the terms and conditions of this manufacturer coupon program;
  3. 2) You will not, at any time, submit any costs for the product dispensed pursuant to this coupon to any government healthcare program for reimbursement;
  4. 3) You are permitting your personal information, including name, address, phone number, email address, and information related to health insurance and treatment, to be shared with Shire and companies working with Shire for the purpose of administering this program; and
  5. 4) You will notify your health insurance provider or other third-party payer of the use of this coupon if required to do so.
  6. If your insurance situation changes it is your responsibility to notify Shire's MyIgCoPayCard program.
  7. For questions about this program, patients and caregivers can call MyIgSource at (855) 250-5111.

Pharmacy instructions

  1. By submitting a claim for reimbursement pursuant to this manufacturer coupon program, the Pharmacy represents and warrants that:
  2. 1) It has dispensed GAMMAGARD LIQUID treatment to an eligible patient and in accordance with the terms and conditions of this program and the accompanying prescription;
  3. 2) Its participation in this program is consistent with all applicable laws and any obligations, including its contract with the applicable payer;
  4. 3) If the patient's insurance situation changes, it will notify Shire immediately by contacting the MyIgCoPayCard program;
  5. 4) It will report coupon assistance received to payers if so required; and
  6. 5) The entire benefit amount received will go to eligible expenses and it will not retain any portion of the benefit as payment to it for administration or ineligible expenses.
  7. For questions regarding processing, claim transmission, patient eligibility, or other issues, pharmacists can call the MyIgCoPayCard program directly at (855) 217-1615.