The RELPAX® (eletriptan HBr) $10 Co-pay Card was designed to help make RELPAX prescriptions more affordable for patients.
If you are eligible, you can get your prescription for no more than $10.
Do you already have a Co-pay Card?
Yes
No
Do you purchase your prescription medicine through Medicare, Medicaid, or a similar federal or state prescription drug program?
Yes
No
We're sorry, but you do not qualify for this offer. Please see Terms and Conditions for details.
I am 18 or older.
Yes
No
We're sorry, but you do not qualify for this offer. Please see Terms and Conditions for details.
*Some exclusions apply. See Terms and Conditions.
Click here for Important Safety Information for RELPAX.

Please note: This Co-pay Card is not health insurance and is only accepted at participating pharmacies. Savings limited to $100 per month for 12 uses. Card may be used once per month.
Pfizer understands your personal and health information is private. The information you provide will only be used by Pfizer and parties acting on its behalf to send you the materials you requested and other helpful information and updates on RELPAX and/or migraines, as well as related treatments, products, offers, and services.
*Some exclusions apply. See Terms and Conditions.
To activate your RELPAX $10 Co-pay Card, please enter your 12-digit ID number located on the back of your Card.
Please enter your card number.
Please provide the information below to activate your card.
FIRST NAME
Please enter your first name.
LAST NAME
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E-MAIL ADDRESS
Please re-enter your e-mail address (eg, name@company.com).
CONFIRM E-MAIL ADDRESS
Error: The two e-mail addresses do not match.
ADDRESS
Please enter your address.
ADDRESS 2 (OPTIONAL)
 
CITY
Please enter your city.
STATE
Please select state.
ZIP
Please enter your zip code.
Click here for Important Safety Information for RELPAX.
*Some exclusions apply. See Terms and Conditions.
Terms and Conditions

By using the RELPAX $10 Co-pay Card, you acknowledge that you currently meet the eligibility criteria and will comply with the terms and conditions described below:

  • Co-pay cards are not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare, or other federal or state healthcare 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"]).
  • Co-pay cards are 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.
  • By using a co-pay card, a patient may pay only $10 per prescription. Savings provided by each co-pay card are limited to $100 per month. Each co-pay card may be used once per month for twelve (12) months. Provided you continue to meet the eligibility criteria, you may be eligible to receive a second co-pay card during the offering.
  • Each patient is limited to one active co-pay card at a time during this offering period and the co-pay cards are not transferable.
  • You must deduct the value received under this program from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf.
  • The co-pay card cannot be combined with any other rebate or coupon, free trial, or similar offer for the specified prescription.
  • The co-pay card will be accepted only at participating pharmacies.
  • The co-pay card is not health insurance.
  • This offer is good only in the United States and Puerto Rico.
  • Pfizer reserves the right to rescind, revoke, or amend the co-pay card without notice.
  • Offer valid from 4/1/11 to 12/31/15. No membership fees apply.

For help with the RELPAX $10 Co-pay Card, call 1-800-926-5334, or write:
Pfizer, ATTN: RELPAX, PO Box 2225, Morrisville, PA 19067-8025.
www.pfizer.com

By clicking this box, I confirm that I am eligible to participate in this program and agree to the Terms and Conditions specified above.
By checking this box, I also agree that Pfizer or companies acting on its behalf may send me materials about other health conditions, use my information to develop or improve products and services, or contact me in the future about health-related topics.

Please agree to the Terms and Conditions before proceeding.
Click here for Important Safety Information for RELPAX.
Pay No More than $10 for your Relpax Prescription, Acitive or Print your Card
Is Your Medicine Really Working? Take the quiz to find out
Learn how Misty found relief with RELPAX
Superior Migraine Pain Relief vs Imitriex®. Find out

This Co-pay Card is not health insurance and is only accepted at participating pharmacies. Savings limited to $100 per month for 12 uses. Card may be used once per month. Terms and conditions apply.

Imitrex (sumatriptan succinate) is a registered trademark of GlaxoSmithKline

Activate or Print Your Card
Activate or Print Your Card
Pay No More than $10 for your Relpax Prescription

This Co-pay Card is not health insurance and is only accepted at participating pharmacies. Savings limited to $100 per month for 12 uses. Card may be used once per month. Terms and conditions apply.

Take the Quiz to Find Out
Take the Quiz to Find Out
Is Your Medicine Really Working?
Find Out
Find Out
Superior Pain Relief

Imitrex (sumatriptan succinate) is a registered trademark of GlaxoSmithKline.

Terms and Conditions

By using the RELPAX $10 Co-pay Card, you acknowledge that you currently meet the eligibility criteria and will comply with the terms and conditions described below:

  • Co-pay cards are not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare, or other federal or state healthcare 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"]).
  • Co-pay cards are 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.
  • By using a co-pay card, a patient may pay only $10 per prescription. Savings provided by each co-pay card are limited to $100 per month. Each co-pay card may be used once per month for twelve (12) months. Provided you continue to meet the eligibility criteria, you may be eligible to receive a second co-pay card during the offering.
  • Each patient is limited to one active co-pay card at a time during this offering period and the co-pay cards are not transferable.
  • You must deduct the value received under this program from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf.
  • The co-pay card cannot be combined with any other rebate or coupon, free trial, or similar offer for the specified prescription.
  • The co-pay card will be accepted only at participating pharmacies.
  • The co-pay card is not health insurance.
  • This offer is good only in the United States and Puerto Rico.
  • Pfizer reserves the right to rescind, revoke, or amend the co-pay card without notice.
  • Offer valid from 4/1/11 to 12/31/15. No membership fees apply.

For help with the RELPAX $10 Co-pay Card, call 1-800-926-5334, or write:
Pfizer, ATTN: RELPAX, PO Box 2225, Morrisville, PA 19067-8025.
www.pfizer.com

INDICATION

RELPAX® (eletriptan HBr) is indicated for the acute treatment of migraine with or without aura in adults. RELPAX should only be used where a clear diagnosis of migraine has been established. RELPAX is not for the prevention of migraines or other types of headaches, including cluster headache.

IMPORTANT SAFETY INFORMATION

Do not take RELPAX (eletriptan HBr) if you:

Have heart disease or a history of heart disease
Have ischemic bowel disease (inadequate blood supply to the intestine)
Have a history of stroke, transient ischemic attack
Have uncontrolled blood pressure
Have a history or current evidence of hemiplegic or basilar migraines (if you are not sure about this, ask your doctor)
Have taken other migraine medications in the last 24 hours, including other triptans, ergots, or ergot-type medications
Have peripheral vascular disease (e.g. narrowing of blood vessels to the legs, arms, stomach, intestines, or kidneys)
Are allergic to RELPAX or any of its ingredients
RELPAX should not be used within at least 72 hours of treatment with the following medicines: Nizoral® (ketoconazole), Sporanox® (itraconazole), Serzone® (nefazodone), TAO® (troleandomycin), Biaxin® (clarithromycin), Norvir® (ritonavir), and Viracept® (nelfinavir)

All brands are trademarks of their owners.

Patients taking RELPAX may experience serious side effects, including:

Heart attacks and other heart problems. Heart problems may lead to death. Stop taking RELPAX and get emergency medical help right away if you have any symptoms of heart attack like discomfort in the center of your chest that lasts for more than a few minutes, or that goes away and comes back; chest pain or chest discomfort that feels like an uncomfortable heavy pressure; squeezing, fullness, or pain; pain or discomfort in your arms, back, neck, jaw, or stomach; shortness of breath with or without chest discomfort; breaking out in a cold sweat; nausea or vomiting; feeling lightheaded.

Medication overuse headaches. Some patients who take too many RELPAX may have worse headaches. If your headaches get worse your doctor may decide to stop your treatment with RELPAX.

Serotonin syndrome is a serious and life-threatening problem that can happen when taking RELPAX, especially when used with certain medications commonly used to treat depression such as selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). Tell your doctor right away if you experience mental changes such as hallucinations, fast heartbeat, high body temperature, trouble walking, or nausea, vomiting or diarrhea.

Changes in color or sensation in your fingers and toes (Raynaud’s syndrome).

Stomach and intestinal problems like sudden or severe stomach pain, stomach pain after meals, weight loss, nausea or vomiting, constipation or diarrhea, bloody diarrhea, fever.

Problems with blood circulation to your legs and feet (cramping and pain in your legs or hips); like feeling of heaviness or tightness in your leg muscles, burning or aching in your feet or toes while resting, numbness, tingling, or weakness in your legs, cold feeling or color changes in 1 or both legs or feet.

Most common side effects are dizziness, nausea, weakness, tiredness and drowsiness. If you have these symptoms, do not drive a car or do anything where you need to be alert. Tell your doctor about any side effects you have.

RELPAX should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Need help paying for your Pfizer medicines?
Pfizer Helpful Answers® may be able to help, regardless of your insurance situation.
Learn how at www.PHAHelps.com