DETERMINE
ELIGIBILITY

IS THE FOCALIN XR®
CO-PAY CARD*
RIGHT FOR YOU?

To find out if you are eligible for the FOCALIN XR Co-Pay Card, simply answer the questions below. Please note that this information must be entered by you or a caregiver, and cannot be entered by a third party.

*Limitations apply. Up to $720 annual limit. Offer not valid under Medicare, Medicaid, or any other federal or state program. Novartis reserves the right to rescind, revoke, or amend this program without notice. Limitations apply in MA and CA. See complete Terms & Conditions for details.

CO-PAY CARD
REGISTRATION

Privacy Notice: The personal information we collect from you, including your card usage, may be used to bring you information about Novartis Pharmaceuticals Corporation products, programs, support, and services, including co-pay card updates. You may unsubscribe from our programs and services at any time by calling 1-888-669-66821-888-669-6682. For more information about our privacy practices, please see the Privacy Policy.

START USING YOUR CARD

Print and use the co-pay card below at your next pharmacy visit.
Please call 1-866-877-4633.1-866-877-4633. if you have issues using your card.

ELIGIBILITY

REGISTER

COMPLETE

I certify that I am over the age of 18 and that I am the patient, or have the patient's consent/legal authority to enroll in the FOCALIN XR Co-Pay Card.

You must be 18 years or older to complete this enrollment form. Please have a parent or caregiver who is at least 18 years of age complete the enrollment process or call 1-866-877-4633.1-866-877-4633.

Do you have private (non-governmental) insurance to cover the costs of your prescription medication? This includes, but it is not limited to, employer sponsored plans, including the Federal Employees Health Benefits (FEHB) Program, or plans from the Health Care Marketplace ("Exchanges").

Patient Ineligible: It doesn't appear that you are eligible for the FOCALIN XR Co-Pay Card, as it's only valid for those with private (nongovernmental) insurance. If you are unsure about your type of insurance, please contact your insurer or call 1-800-245-5356.1-800-245-5356. to find out if there are other forms of support for you. Learn more .

Are you a resident of Massachusetts or California?

Patient Ineligible: It doesn't appear that you are eligible for the FOCALIN XR Co-Pay Card, as the offer is not valid for Massachusetts or California residents. Please call 1-800-245-5356.1-800-245-5356. to find out if there are other forms of support for you. Learn more .

Are you enrolled in a federal or state health care program or plan that helps cover the cost of your prescription medication? This includes, but is not limited to, Medicare Part D, Medicare Advantage, Medicaid, VA, DoD, TRICARE, and any other government-sponsored pharmaceutical benefit program.

Patient Ineligible: It doesn't appear that you are eligible for the FOCALIN XR Co-Pay Card, as the offer is not valid under Medicare, Medicaid, or any other federal or state program. If you are unsure about your type of insurance, please contact your insurer or call 1-800-245-5356.1-800-245-5356. to find out if there are other forms of support for you. Learn more .

Are you paying cash for the full price of the prescription?

Patient Ineligible: It doesn't appear that you are eligible for the FOCALIN XR Co-Pay Card, as the offer is not valid for cash-paying patients. Please call 1-800-245-5356.1-800-245-5356. to find out if there are other forms of support for you. Learn more .

*Terms and conditions

Limitations apply. Valid only for those with private insurance. The Program includes the Co-Pay Card, Payment Card (if applicable), and Rebate, with a combined annual limit up to $720. Patient pays the first $10 of co-pay. Novartis pays up to the next $60 per 30-day supply. Patient is responsible for any costs once limit is reached in a calendar year. Program not valid (i) under Medicare, Medicaid, TRICARE, VA, DoD, or any other federal or state health care program (ii) where patient is not using insurance coverage at all, (iii), where the patient's insurance plan reimburses for the entire cost of the drug, or (iv) where product is not covered by patient's insurance. The value of this Program is exclusively for the benefit of patients and is intended to be credited towards patient out-of-pocket obligations and maximums, including applicable co-payments, coinsurance, and deductibles. Program is not valid where prohibited by law. Patient may not seek reimbursement for the value received from this Program from other parties, including any health insurance program or plan, flexible spending account, or health care savings account. Patient is responsible for complying with any applicable limitations and requirements of their health plan related to the use of the Program. Valid only in the United States and Puerto Rico. Offer not valid in CA or MA. This Program is not health insurance. Program may not be combined with any third-party rebate, coupon, or offer. Proof of purchase may be required. Novartis reserves the right to rescind, revoke, or amend the Program and discontinue support at any time without notice.

* Required

*Do you/your loved one already have a $10 co-pay card that you need to activate?

*Program Compliance (Attestation): By using the Focalin XR® Co-Pay Card Program, you acknowledge and confirm that at the time of usage the patient meets eligibility criteria as outlined and will comply with the terms and conditions. This offer is valid only for those with private (non-governmental) insurance and who have a valid prescription. Program is not valid (i) under Medicare, Medicaid, TRICARE, VA, DoD, or any other federal or state health care program, (ii) where patient is not using insurance coverage at all, (iii) where the patient's insurance plan reimburses for the entire cost of the drug, or (iv) where product is not covered by patient's insurance. Offer not valid in CA or MA. This offer is not valid where prohibited by law and is only valid in the United States and Puerto Rico. This program is not health insurance. Program may not be combined with any third-party rebate, coupon, or offer. Proof of purchase may be required. The card you will receive is the property of Novartis Pharmaceuticals Corporation and must be returned upon request. Novartis reserves the right to rescind, revoke, or amend the Program and discontinue support at any time without notice. You certify responsibility for complying with applicable limitations, if any, of any commercial insurance and reporting receipt of program rewards, if necessary, to any commercial insurer. Present this offer and your insurance card along with a valid prescription at any participating pharmacy. Patients with commercial insurance pay the first $10 of co-pay. Novartis pays up to the next $60 per 30-day supply. Patient pays remaining co-pay amount. The Novartis co-pay support of $60 per month is not to exceed an annual maximum of $720. Questions should be directed to: 1-866-877-4633. 1-866-877-4633. When you use this offer, you are certifying that you understand the program rules, regulations, and terms and conditions, and that you will disclose and report the use of this offer as may be required by your insurer. You are not eligible if prescriptions are period by any federal or state program, or where prohibited by law; and you will otherwise comply with the terms and conditions above. The Novartis Co-Pay Savings Program requires annual review of the program eligibility. The information you/the patient provide(s) may be used to contact the patient about this program.

By clicking "SUBMIT", I agree to the Novartis Pharmaceuticals Corporation Terms of Use. I understand and agree that the information I provide will be used in accordance with the Novartis Pharmaceuticals Corporation Privacy Policy including to provide me with marketing information, offers, and promotions, and to contact me for my opinions regarding products, programs, and services. I understand that unless I unsubscribe, by calling 1-888-669-6682 1-888-669-6682 or by clicking "unsubscribe" in a promotional e-mail, my consent will remain valid.

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IMPORTANT SAFETY INFORMATION

IMPORTANT SAFETY INFORMATION
AND INDICATION

What is the most important information I should know about FOCALIN XR?

FOCALIN XR is a federal controlled substance (CII) because it can be abused or lead to dependence. Keep FOCALIN XR in a safe place to prevent misuse and abuse. Selling or giving away FOCALIN XR may harm others, and is against the law.

INDICATION

What is FOCALIN XR?

  • FOCALIN XR is a central nervous system (CNS) stimulant prescription medicine. It is used for the treatment of Attention-Deficit Hyperactivity Disorder (ADHD). FOCALIN XR may help increase attention and decrease impulsiveness and hyperactivity in patients with ADHD.

VIEW LESS

IMPORTANT SAFETY INFORMATION

IMPORTANT SAFETY INFORMATION
AND INDICATION

What is the most important information I should know about FOCALIN XR?

FOCALIN XR is a federal controlled substance (CII) because it can be abused or lead to dependence. Keep FOCALIN XR in a safe place to prevent misuse and abuse. Selling or giving away FOCALIN XR may harm others, and is against the law.

INDICATION

What is FOCALIN XR?

  • FOCALIN XR is a central nervous system (CNS) stimulant prescription medicine. It is used for the treatment of Attention-Deficit Hyperactivity Disorder (ADHD). FOCALIN XR may help increase attention and decrease impulsiveness and hyperactivity in patients with ADHD.

  • FOCALIN XR should be used as a part of a total treatment program for ADHD that may include counseling or other therapies.

Tell your doctor if you or your child have abused or been dependent on alcohol, prescription medicines, or street drugs.

Who should not take FOCALIN XR?

FOCALIN XR should not be taken if you or your child:

  • are allergic to methylphenidate hydrochloride, or any of the ingredients in FOCALIN XR.

  • are taking or have taken within the past 14 days an anti-depression medicine called a monoamine oxidase inhibitor or MAOI.

The following have been reported with use of methylphenidate hydrochloride and other stimulant medicines:

  • Heart-related problems: Sudden death in patients who have heart problems or heart defects, stroke and heart attack in adults, increased blood pressure and heart rate.Tell your doctor if you or your child have any heart problems, heart defects, high blood pressure, or a family history of these problems. Your doctor should check you or your child carefully for heart problems before starting FOCALIN XR and then check blood pressure and heart rate regularly during treatment with FOCALIN XR. Call your doctor right away if you or your child has any signs of heart problems such as chest pain, shortness of breath, or fainting while taking FOCALIN XR.

  • Mental (psychiatric) problems: New or worse behavior and thought problems, new or worse bipolar illness, new or worse aggressive behavior or hostility, new psychotic symptoms (such as hearing voices, believing things that are not true, are suspicious) or new manic symptoms. Tell your doctor about any mental problems you or your child have, or about a family history of suicide, bipolar illness, or depression. Call your doctor right away if you or your child have any new or worsening mental symptoms or problems while taking FOCALIN XR, especially seeing or hearing things that are not real, believing things that are not real, or are suspicious.

FOCALIN XR may not be right for you or your child. Before starting FOCALIN XR, tell your or your child's doctor about all health conditions (or family history) including:

  • if you are pregnant or plan to become pregnant. It is not known if FOCALIN XR will harm your unborn baby.

    • There is a pregnancy registry to collect information about the health of pregnant females exposed to FOCALIN XR and their baby. If you or your child becomes pregnant during treatment with FOCALIN XR, talk to your healthcare provider about registering with the National Pregnancy Registry of ADHD medications at 1-866-961-23881-866-961-2388 or visit online at https://womensmentalhealth.org/adhd-medications/ .

  • if you are breastfeeding or plan to breastfeed. FOCALIN XR passes into your breast milk. Talk to your healthcare provider about the best way to feed the baby during treatment with FOCALIN XR.

Tell your doctor about all of the medicines that you or your child takes, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Do not start any new medicine while taking FOCALIN XR without talking to your doctor first.

What are the possible side effects of FOCALIN XR?

FOCALIN XR may cause serious side effects, including:

  • painful and prolonged erections (priapism) have occurred with methylphenidate. If you or your child develops priapism, seek medical help right away. Because of the potential for lasting damage, priapism should be evaluated by a doctor immediately.

  • circulation problems in fingers and toes (peripheral vasculopathy, including Raynaud's phenomenon), where fingers or toes may feel numb, cool, painful, or may change color from pale, to blue, to red. Tell your doctor if you or your child have numbness, pain, skin color change, or sensitivity to temperature in the fingers or toes.

  • Call your doctor right away if you have or your child has any signs of unexplained wounds appearing on fingers or toes while taking FOCALIN XR.

  • slowing of growth (height and weight) in children. Children should have their height and weight checked often while taking FOCALIN XR. Treatment may be stopped if a problem is found during these check-ups.

Common side effects include:

  • Children (6-17 years): Dyspepsia, decreased appetite, headache, anxiety

  • Adults: Dry mouth, dyspepsia, headache, anxiety, pharyngolaryngeal pain

FOCALIN XR can be taken with or without food. Do not chew, crush, or divide the capsules or the beads in the capsule. If you or your child cannot swallow the capsule, open it and sprinkle the small beads of medicine over a spoonful of applesauce and swallow it right away without chewing.

INDICATION

What is FOCALIN XR?

  • FOCALIN XR is a central nervous system (CNS) stimulant prescription medicine. It is used for the treatment of Attention-Deficit Hyperactivity Disorder (ADHD). FOCALIN XR may help increase attention and decrease impulsiveness and hyperactivity in patients with ADHD.

  • FOCALIN XR should be used as a part of a total treatment program for ADHD that may include counseling or other therapies.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.1-800-FDA-1088.

Please see full Prescribing Information, including Boxed WARNING and Medication Guide.