LiDORx (Lidocaine HCL USP 3%) Mobile Program: Terms, Conditions, and Eligibility Requirements:

By participating in the LiDORx (Lidocaine HCL USP 3%) Mobile Program (“Program”) sponsored by Gensco Pharma, you acknowledge that you currently meet the eligibility criteria and will comply with the terms and conditions described below:

• The Program is not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare, or other federal or state health care programs, including any state prescription drug assistance programs and the Government Health Insurance Plan available in Puerto Rico (formerly known as “La Reforma De Salud”).
• Absent a change in Massachusetts law, effective July 1, 2015, the discount will no longer be valid for residents of Massachusetts.
• The Program is not valid for prescriptions that are eligible to be reimbursed by private insurance plans or other health or pharmacy benefit programs that reimburse you for the entire cost of your prescription drugs.
• Patients must be 18 or older. Cash paying patients and privately insured patients are eligible for savings. Patients will pay a minimum of $20 per fill for all eligible prescription sizes of LiDORx.
• For LiDORx size 30 mL, cash paying patients pay a minimum copay of $20 and are eligible for a maximum savings of up to $62.27 per fill. Privately insured patients pay a minimum copay of $20 and are eligible for maximum savings of up $25.45. For LiDORx size 10 mL, cash paying and privately insured patients pay a minimum copay of $20 with a maximum savings of up to $10 per fill.
• This discount is not health insurance. This Program is good only in the United States and Puerto Rico. You must deduct the value received under this Mobile Program from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf.
• The Program cannot be combined with any other rebate or coupon, free trial, or similar offer for the specified prescription.
• It is illegal to sell, purchase, trade, or counterfeit, or offer to sell, purchase, trade, or counterfeit the discount card. Void if reproduced. Void where prohibited by law, taxed, or restricted.
• The discount will be accepted only at participating pharmacies. Participating mail order pharmacies must receive the program details, including the pharmacy processing line (888-445-5573) along with your prescription to process the offer.
• The discount will be accepted only at participating pharmacies. Participating mail order pharmacies must receive the program details, including the pharmacy processing line (888-445-5573) along with your prescription to process the offer.
• Under the Program you may receive information about your prescription via text message. Standard message and data rates may apply. You may receive an average of 8 messages per month during the course of this program. Text messages received within the Program are automated and responses are not read by any person.
• If you wish to opt out at any time during the program, text STOP to opt out. Text HELP for help.
• Gensco Pharma reserves the right to rescind, revoke, or amend the discount without notice. For questions about this discount program or how to opt out, please call 855-7GENSCO (855-746-6726). No membership fees required.
• The discount card is the property of Gensco Pharma and must be turned in on request.

© 2015 Gensco Pharma. All rights reserved. For full LiDORx Prescribing information click here