Terms and Conditions | RELPAX® (eletriptan HBr)


By using the RELPAX $4 Savings Offer, you acknowledge that you currently meet the eligibility criteria and will comply with the terms and conditions described below:

  • This Savings Offer is not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare, Tricare, 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”)
  • You must deduct the savings received under this program from any reimbursement request submitted to your insurance plan, either directly by you or on your behalf
  • Eligible patients may pay as little as $4 per monthly prescription. Savings provided by each Savings Offer is limited to $150 per month. Each Savings Offer 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 Savings Offer during the offering
  • This Savings Offer is not valid when the entire cost of your prescription drug is eligible to be reimbursed by your private insurance plans or other health or pharmacy benefit programs
  • The Savings Offer is not valid for Massachusetts residents whose prescriptions are covered, in whole or in part, by third-party insurance
  • This Savings Offer is not valid where prohibited by law
  • The Savings Offer cannot be combined with any other rebate/coupon, free trial, or similar offer for the specified prescription
  • The Savings Offer may not be redeemed more than once per month per patient
  • The Savings Offer will be accepted only at participating pharmacies
  • The Savings Offer is not health insurance
  • This Savings Offer is good only in the U.S. and Puerto Rico
  • The Savings Offer is limited to 1 per person during this offering period and is not transferable
  • Pfizer reserves the right to rescind, revoke, or amend the program without notice
  • No membership fees. The Savings Offer and Program expire on 12/31/2020

For help with the RELPAX $4 Savings Offer, call 1-800-926-5334, visit RELPAX.com, or write: Pfizer, ATTN: RELPAX, PO Box 4937, Warren, NJ 07059-6600. 

For reimbursement when using a nonparticipating pharmacy/mail order: Pay for your RELPAX prescription and mail copy of original pharmacy receipt (cash register receipt NOT valid) with product name, date, and amount circled to: Pfizer, ATTN: RELPAX, PO Box 4937, Warren, NJ 07059-6600. Be sure to include a copy of the front of your RELPAX Savings Offer, your name, and mailing address. Please expect up to 4 to 6 weeks for reimbursement.


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