Free Trial Offer and Savings Card

Are your patients concerned about the price of their medication? Help your eligible patients pay less out of pocket on the cost of BRILINTA

One month FREE plus savings on refills* for eligible commercially insured patients

With the BRILINTA Savings Card, most commercially insured patients will pay only $18 per month for up to 1 year.

  • Eligible patients can receive savings on out-of-pocket costs that exceed $18 (up to a $75 savings limit) on each 30-day supply of BRILINTA. See eligibility rules below

Medicare and Medicaid patients receive ONE MONTH free*

*Subject to eligibility rules; restrictions apply.

BRILINTA Savings Card Coupon

DOWNLOAD A FREE TRIAL OFFER AND BRILINTA SAVINGS CARD* >>

Download and Print Free Trial Offer and Savings Card*

You can download and print a Free Trial Offer and Savings Card* for each of your eligible patients. Every download will have a unique number, so please don't make duplicates of the same card.

Other ways for eligible patients to access savings offers

Filling prescriptions for BRILINTA through mail order

Mail Order

If your patients fill their prescriptions through mail order, they can request a rebate form by clicking here or by calling 1-888-512-7454.

Registering online for Free Trial Offer

Registration of Free Trial Offer

Your patients can register their Free Trial Offer online or by calling 1-888-512-7454.

Please Note: If you are a health care professional affiliated with an employer, institution, or committee, or practicing in a state that restricts what items you may receive from manufacturers, we ask that you not accept or download any restricted items from this site. If you are a health care provider practicing in Vermont, we are required by state law to deny you permission to download any items made available on this site.

Eligibility Requirements and Information

Free Trial Offer Eligibility

This offer is good for eligible patients purchasing up to a 30-day supply (up to 60 tablets) of BRILINTA® (ticagrelor) tablets and may not be used for any other product. This offer is good for the purchase of BRILINTA manufactured for AstraZeneca Pharmaceuticals LP and lawfully purchased from an authorized retailer or distributor in the United States or its territories. This offer may be used by eligible patients who participate in Medicaid, Medicare, or similar federal or state programs, or by patients who are Medicare eligible and enrolled in an employer-sponsored group waiver health plan or government-subsidized prescription drug benefit program for retirees. This offer may also be used by eligible patients who have commercial insurance or pay cash for their prescriptions. This offer is not insurance and is not valid for mail order, or for patients under 18 years of age. Offer not valid where prohibited by law, taxed, or restricted. Offer is not transferable, is limited to one per person, and may not be combined with any other offer. Offer must be presented along with a valid prescription for BRILINTA at the time of purchase.

Medicaid or Medicare Patients: You will receive one 30-day prescription free.

Commercially Insured or Cash-Paying Patients: If you have commercial insurance, you will receive 100% off your copay for one 30-day prescription; if you pay cash for your prescriptions, you will receive one 30-day prescription free.

If you have any questions regarding this offer, please call 1-888-512-7454. AstraZeneca reserves the right to change or discontinue this offer at any time without notice.

Program managed by PSKW, LLC, on behalf of AstraZeneca.

Savings Card

ELIGIBILITY: You may be eligible for this offer if you are insured by commercial insurance and your insurance does not cover the full cost of your prescription, or you are not insured and are responsible for the cost of your prescriptions.

Patients who are enrolled in a state or federally funded prescription insurance program are not eligible for this offer. This includes patients enrolled in Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DOD) programs or TriCare, and patients who are Medicare eligible and enrolled in an employer-sponsored group waiver health plan or government-subsidized prescription drug benefit program for retirees.

If you are enrolled in a state or federally funded prescription insurance program, you may not use this Savings Card even if you elect to be processed as an uninsured (cash-paying) patient.

This offer is not insurance and is restricted to residents of the United States and Puerto Rico and patients over 18 years of age. This offer is valid for retail prescriptions only.

TERMS OF USE: Eligible commercially insured patients with a valid prescription for BRILINTA® (ticagrelor) tablets who present this Savings Card at participating pharmacies will pay $18 per 30-day supply, subject to a maximum savings of $75 per 30-day supply. Cash-paying patients will receive up to $75 in savings on out-of-pocket costs per 30-day supply. This offer is good for a 30-day supply, 60-day supply, or 90-day supply. This offer is good for 12 uses and each 30-day supply counts as 1 use. Other restrictions may apply. Patient is responsible for applicable taxes, if any. If you have any questions regarding this offer, please call 1-888-512-7454.

Nontransferable, limited to one per person, cannot be combined with any other offer. Void where prohibited by law, taxed, or restricted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer. AstraZeneca reserves the right to rescind, revoke, or amend this offer, eligibility, and terms of use at any time without notice. This offer is not conditioned on any past, present, or future purchase, including refills. Offer must be presented along with a valid prescription for BRILINTA at the time of purchase.

BY USING THIS CARD, YOU AND YOUR PHARMACIST UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

Program managed by PSKW, LLC, on behalf of AstraZeneca.

Mail-Order Rebate

ELIGIBILITY: You may be eligible for this offer if you are insured by commercial insurance and your insurance does not cover the full cost of your prescription, or you are not insured and are responsible for the cost of your prescriptions.

Patients who are enrolled in a state or federally funded prescription insurance program are not eligible for this offer. This includes patients enrolled in Medicare Part D, Medicaid, Medigap, Veterans Affairs (VA), Department of Defense (DOD) programs or TriCare, and patients who are Medicare eligible and enrolled in an employer-sponsored group waiver health plan or government-subsidized prescription drug benefit program for retirees.

If you are enrolled in a state or federally funded prescription insurance program, you may not use this rebate form even if you elect to be processed as an uninsured (cash-paying) patient.

This offer is not insurance and is restricted to residents of the United States and Puerto Rico and patients over 18 years of age.

TERMS OF USE: This offer is good for eligible patients purchasing a 90-day supply (up to 180 tablets) of BRILINTA® (ticagrelor) tablets through a mail-order pharmacy and may not be used for any other product. If you have commercial insurance for your prescriptions and your co-pay is more than $54 for a 90-day supply, you will pay the first $54 and receive up to $225 in savings from AstraZeneca. If you pay cash for your prescriptions, you will receive up to $225 in savings from AstraZeneca for a 90-day supply. This offer is good for a 90-day supply (up to 4 fills). If you have any questions regarding this offer, please call 1-888-512-7454.

Nontransferable, limited to one per person, cannot be combined with any other offer. Void where prohibited by law, taxed, or restricted. Patients, pharmacists, and prescribers cannot seek reimbursement from health insurance or any third party for any part of the benefit received by the patient through this offer. AstraZeneca reserves the right to rescind, revoke, or amend this offer, eligibility, and terms of use at any time without notice. This offer is not conditioned on any past, present, or future purchase, including refills. Offer must be presented along with a valid prescription for BRILINTA at the time of purchase.

BY USING THIS REBATE FORM, YOU AND YOUR PHARMACIST UNDERSTAND AND AGREE TO COMPLY WITH THESE ELIGIBILITY REQUIREMENTS AND TERMS OF USE.

Program managed by PSKW, LLC, on behalf of AstraZeneca.

1733068-2974913 Last Updated 11/14

IMPORTANT SAFETY INFORMATION ABOUT BRILINTA

WARNING: (A) BLEEDING RISK, (B) ASPIRIN DOSE AND BRILINTA EFFECTIVENESS A. BLEEDING RISK

  • BRILINTA, like other antiplatelet agents, can cause significant, sometimes fatal, bleeding
  • Do not use BRILINTA in patients with active pathological bleeding or a history of intracranial hemorrhage
  • Do not start BRILINTA in patients planned to undergo urgent coronary artery bypass graft surgery (CABG). When possible, discontinue BRILINTA at least 5 days prior to any surgery
  • Suspect bleeding in any patient who is hypotensive and has recently undergone coronary angiography, percutaneous coronary intervention (PCI), CABG, or other surgical procedures in the setting of BRILINTA
  • If possible, manage bleeding without discontinuing BRILINTA. Stopping BRILINTA increases the risk of subsequent cardiovascular events

B. ASPIRIN DOSE AND BRILINTA EFFECTIVENESS

  • Maintenance doses of aspirin above 100 mg reduce the effectiveness of BRILINTA and should be avoided. After any initial dose, use with aspirin 75 mg - 100 mg per day

CONTRAINDICATIONS

  • BRILINTA is contraindicated in patients with a history of intracranial hemorrhage and active pathological bleeding such as peptic ulcer or intracranial hemorrhage. BRILINTA is contraindicated in patients with severe hepatic impairment because of a probable increase in exposure; it has not been studied in these patients. Severe hepatic impairment increases the risk of bleeding because of reduced synthesis of coagulation proteins. BRILINTA is also contraindicated in patients with hypersensitivity (eg, angioedema) to ticagrelor or any component of the product

WARNINGS AND PRECAUTIONS

  • Moderate Hepatic Impairment: Consider the risks and benefits of treatment, noting the probable increase in exposure to ticagrelor
  • Premature discontinuation increases the risk of MI, stent thrombosis, and death
  • Dyspnea was reported in 14% of patients treated with BRILINTA and in 8% of patients taking clopidogrel. Dyspnea resulting from BRILINTA is self-limiting. Rule out other causes
  • BRILINTA is metabolized by CYP3A4/5. Avoid use with strong CYP3A inhibitors and potent CYP3A inducers. Avoid simvastatin and lovastatin doses >40 mg
  • Monitor digoxin levels with initiation of, or any change in, BRILINTA therapy

ADVERSE REACTIONS

  • The most commonly observed adverse reactions associated with the use of BRILINTA vs clopidogrel were Total Major Bleeding (11.6% vs 11.2%) and dyspnea (14% vs 8%)
  • In clinical studies, BRILINTA has been shown to increase the occurrence of Holter-detected bradyarrhythmias. PLATO excluded patients at increased risk of bradycardic events. Consider the risks and benefits of treatment

INDICATIONS

BRILINTA is indicated to reduce the rate of thrombotic cardiovascular (CV) events in patients with acute coronary syndrome (ACS) (unstable angina, non–ST-elevation myocardial infarction, or ST-elevation myocardial infarction). BRILINTA has been shown to reduce the rate of a combined end point of CV death, myocardial infarction (MI), or stroke compared to clopidogrel. The difference between treatments was driven by CV death and MI with no difference in stroke. In patients treated with PCI, it also reduces the rate of stent thrombosis.

BRILINTA has been studied in ACS in combination with aspirin. Maintenance doses of aspirin >100 mg decreased the effectiveness of BRILINTA. Avoid maintenance doses of aspirin >100 mg daily.

Please read full Prescribing Information , including Boxed WARNINGS, and Medication Guide  for BRILINTA.

“Patients” means covered lives (Commercial, Commercial [BCBS], Employer, Municipal Plan, PBM, Union) at Tiers 1-7 in the US, as calculated by Fingertip Formulary.

"Patients" means covered lives (Medicare MA, Medicare PDP, Medicare SN) at Tiers 1-7 in the US, as calculated by Fingertip Formulary.

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.