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ELIGIBILITY REQUIREMENTS

ELIGIBILITY: Patients may be eligible for this offer if they have commercial insurance and insurance does not cover the full cost of the prescription or if they are not insured and are responsible for the cost of their prescriptions. Government beneficiaries; patients who are enrolled in any federal healthcare program, including patients enrolled in Medicare (Part D or otherwise), Medicaid, Medigap, Veterans Affairs (VA) or Department of Defense (DOD) programs, or TRICARE; patients who are Medicare eligible and enrolled in an employer-sponsored group waiver health plan or government prescription drug benefit program for retirees; or patients enrolled in any similar federal or state programs, including state pharmaceutical assistance programs, are NOT eligible for this offer. Further, patients CANNOT use this coupon if they are Medicare eligible. For coupon eligibility purposes, all those 65 or older will be considered Medicare eligible. If patients are government beneficiaries or Medicare eligible, they may not use this savings offer even if they elect to be processed as an uninsured (cash-paying) patient. This offer is not health insurance and is restricted to residents of the United States, Puerto Rico, and US territories. Void where prohibited by law, taxed, or restricted. Not valid in Massachusetts or California if an AB-rated generic drug is available for the product.

TERMS OF USE: Eligible commercially insured/covered patients with no restrictions (e.g., step-edit, prior authorization, or NDC block) and patients with a valid prescription for BREO ELLIPTA (fluticasone furoate and vilanterol inhalation powder) who present this savings card at participating pharmacies will pay the first $10, and receive up to $100 off each 30-day prescription or refill of BREO applied to their out-of-pocket cost. If you pay cash for your prescription, or are insured and your insurance does not cover or has a managed care restriction (e.g., step-edit, prior authorization, or NDC block), and are not a government beneficiary or Medicare eligible, you will receive up to $100 in savings on your out-of-pocket costs for each 30-day supply for each product. This offer is valid for up to 12 uses per product, and each 30-day supply per product counts as 1 use. Other restrictions may apply. Patient is responsible for applicable taxes, if any. This offer is limited to 1 per person and is nontransferable and cannot be combined with any other coupon, free trial, or similar offer. No substitutions are permitted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the amount received by the patient through this offer. Offer must be presented along with a valid prescription for BREO at the time of purchase. Your acceptance of this offer must be consistent with the terms of any drug benefit plan provided to you by your health insurer. You agree to report your use of this coupon to your health insurer if required.

GSK or McKesson (on GSK’s behalf) reserves the right to rescind, revoke, or amend this offer at any time without notice. This offer may not be sold, purchased, traded, or counterfeited. Duplicates of this uniquely coded offer are invalid and not redeemable at the pharmacy. This offer is not conditioned on any past, present, or future purchase, including refills. This offer expires on 06/30/2020.

Take the Asthma
Control TestTM

How well controlled are your asthma symptoms?

Current asthma guidelines suggest that if you are using your rescue inhaler more than 2 days a week to treat sudden symptoms, your asthma may not be well controlled. You can also take a test that will help you determine this. Partner with your doctor to find a treatment plan that works for you to help control your asthma symptoms.

How to take the Asthma Control Test

Answer the 5 questions below. For each question, make sure you read all 5 possible answers before choosing the best one for you. A number score will appear in the column to the right. When you’re finished, click “Get my results” to view your score. Your score will be explained after you take the test.

The results of the questionnaire are not intended to diagnose a condition or disease state and do not replace the advice of a qualified healthcare professional.

1.

In the past 4 weeks, how much of the time did your asthma keep you from getting as much done at work, school, or at home?

SCORE

2.

During the past 4 weeks, how often have you had shortness of breath?

SCORE

3.

During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness or pain) wake you up at night or earlier than usual in the morning?

SCORE

4.

During the past 4 weeks, how often have you used your rescue inhaler or nebulizer medication (such as albuterol)?

SCORE

5.

How would you rate your asthma control during the past 4 weeks?

SCORE

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Asthma Control Test is a trademark of QualityMetric Incorporated.