SAVINGS & ADDITIONAL INFORMATION FOR BREO ELLIPTA

Talk to your doctor about 24-hour BREO, a prescription medicine for adults with asthma who need both an ICS (inhaled corticosteroid) and a LABA (long-acting beta2-adrenergic agonist) medicine. BREO is not for people whose asthma is well controlled on an asthma control medicine, like an ICS. BREO is not used to relieve sudden breathing problems and won't replace a rescue inhaler.

Please answer the questions below to receive important information and to see if you qualify for a BREO coupon to save on your 30-day prescription for 12 months. See additional information.

GET MORE INFORMATION AND SEE IF YOU’RE ELIGIBLE TO PAY NO MORE THAN $10 A MONTH*

Enter your information below:
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1. Which of the following statements best describes you?
If you are interested in receiving more information about BREO, including free tools and future savings offers, please provide the information below:
2. Are you enrolled in any state-, federal-, or government-funded medical or prescription benefit program, including but not limited to Medicare, Medicaid, Medigap, VA, DOD, TRICARE, or CHAMPUS?

TRICARE is a registered trademark of the Department of Defense. All rights reserved.

Program Enrollment:

GlaxoSmithKline (GSK) believes your privacy is important. By providing your name, address, email address, and other information, you are giving GSK and companies working with GSK permission to market or advertise to you across multiple channels, eg, mail, email, websites, online advertising, applications, and services regarding the medical condition(s) in which you have expressed an interest, as well as other health-related information from GSK. GSK will not sell or transfer your name, address, or email address to any other party for their own marketing use.

For additional information regarding how GSK handles your information, please see our privacy statement.

Savings Offer Consent:

I'd like to receive savings offers on my prescription. I understand that by selecting "I agree" below, I am agreeing that GSK and companies working with GSK (for example, the program administrator) can use the personal information I provide when I enroll, as well as information received from my pharmacy about my use of the savings offer and the date on which I filled my prescription. GSK and the program administrator have my consent to use the information to select additional mailings and offers that may be of interest to me in connection with this program. I understand that I can revoke this authorization at any time by contacting GSK at 1-888-825-5249 or https://www.contactus.gsk.com/optout/index.html and that even if I decide not to participate in this GSK offer, it will not impact my ability to receive treatment from my healthcare provider.

*Subject to eligibility. Restrictions apply.

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Additional information about the coupon:

  • Read Full Requirements and Restrictions. Subject to eligibility. Restrictions apply.
  • Eligible commercially insured patients will pay $10 per 30-day supply of BREO.
  • Eligible patients without insurance to cover the cost of their prescription will receive up to $100 in savings on each 30-day supply of BREO. You will be responsible for any remaining out-of-pocket cost.
  • This is NOT health insurance.
  • Keep this coupon. It can be used once per month for up to 12 months prior to the expiration date. In order to receive 12 uses, the first use must occur before 01/31/20. Each 30-day supply counts as 1 use.
  • Coupon should be presented to your pharmacist for each refill.

Important Safety Information for BREO ELLIPTA

  • BREO contains vilanterol. LABA medicines such as vilanterol when used alone increase the risk of hospitalizations and death from asthma problems. BREO contains an ICS and a LABA. When an ICS and LABA are used together, there is not a significant increased risk in hospitalizations and death from asthma problems.

Important Safety Information for BREO ELLIPTA

  • BREO contains vilanterol. LABA medicines such as vilanterol when used alone increase the risk of hospitalizations and death from asthma problems. BREO contains an ICS and a LABA. When an ICS and LABA are used together, there is not a significant increased risk in hospitalizations and death from asthma problems.
  • Do not use BREO to relieve sudden breathing problems. Always have a rescue inhaler with you to treat sudden symptoms.
  • BREO should not be used in children and adolescents. It is not known if BREO is safe and effective in children and adolescents younger than 18 years of age.
  • Do not use BREO if you have a severe allergy to milk proteins or are allergic to any of the ingredients in BREO. Ask your healthcare provider if you are not sure.
  • Do not use BREO more often than prescribed.
  • Do not take BREO with other medicines that contain a LABA for any reason. Tell your healthcare provider about all the medicines you take and about all of your health conditions.
  • Call your healthcare provider or get medical care right away if your breathing problems get worse, if you need your rescue inhaler more often than usual or it does not work as well to relieve your symptoms, or if your peak flow meter results decrease. Your healthcare provider will tell you the numbers that are right for you.
  • BREO can cause serious side effects, including:
    • fungal infection in your mouth or throat (thrush). Rinse your mouth with water without swallowing after using BREO to help reduce your chance of getting thrush.
    • weakened immune system and increased chance of getting infections (immunosuppression). You should avoid exposure to chickenpox and measles, and, if exposed, consult your healthcare provider without delay. Worsening of existing tuberculosis, fungal, bacterial, viral, or parasitic infections, or herpes infection of the eye may occur.
    • reduced adrenal function (adrenal insufficiency). This can happen when you stop taking an oral corticosteroid (such as prednisone) and start taking a medicine containing an ICS (such as BREO). During this transition period, when your body is under stress such as from fever, trauma (such as a car accident), infection, surgery, or worse chronic obstructive pulmonary disease symptoms, adrenal insufficiency can get worse and may cause death. Symptoms include: feeling tired; lack of energy; weakness; nausea and vomiting; low blood pressure (hypotension).
    • sudden breathing problems immediately after inhaling your medicine. If you have sudden breathing problems immediately after inhaling your medicine, stop taking BREO and call your healthcare provider right away.
    • serious allergic reactions. Call your healthcare provider or get emergency medical care if you get any of the following symptoms of a serious allergic reaction: rash; hives; swelling of your face, mouth, and tongue; breathing problems.
    • effects on heart: increased blood pressure; a fast or irregular heartbeat, awareness of heartbeat; chest pain.
    • effects on nervous system: tremor; nervousness.
    • bone thinning or weakness (osteoporosis)
    • eye problems including glaucoma and cataracts. You should have regular eye exams while using BREO.
    • changes in laboratory blood values: high blood sugar (hyperglycemia) and low potassium (hypokalemia).
    • slowed growth in children.
  • Common side effects of BREO for asthma include: runny nose and sore throat; thrush in your mouth or throat–Rinse your mouth with water without swallowing after use to help prevent this; headache; flu; respiratory tract infection; bronchitis; inflammation of the sinuses; mouth and throat pain; hoarseness and voice changes; cough.

You are encouraged to report negative side effects of prescription drugs to the FDA.

Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.