Print this page and take it to your pharmacy with your prescription.

You can also call 1-866-398-0833 for prescription
coverage assistance or to enroll in a program
that provides prescription refill reminders
and the ability to refill Oxtellar XR®
prescriptions via text message.

1075332727

TERMS & CONDITIONS

This offer is good for commercially insured and cash-paying patients purchasing Oxtellar XR® (oxcarbazepine) extended-release tablets and may not be used for any other product. Maximum benefits apply. This offer is not valid for prescriptions purchased under Medicaid, Medicare, or other federal or state programs (such as medical assistance programs). Offer not valid where prohibited by law, taxed, or restricted. It is not transferable and may not be combined with any other offer. The amount of the rebate cannot exceed the patient’s actual out-of-pocket expenses up to a maximum of $250 per prescription. Offer must be presented along with a valid prescription for Oxtellar XR® at the time of purchase. By enrolling into this program you are consenting to the collection and use of certain personal information including your phone number and/or email address and elements of pharmacy claim information. This information will be collected and used by service providers of Supernus Pharmaceuticals, Inc. (“Supernus”), in order to administer this program. This information is not provided to Supernus directly. If you do not consent, please do not enroll into the program. Text messages received with the mobile program are automated, and responses are not read by any person. Text STOP to opt out at any time. If you require additional assistance, please call 1-866-398-0833. Supernus reserves the right to rescind, revoke, or amend this offer without notice at any time.

INSTRUCTIONS

This card is provided to you as a service by your doctor and Supernus Pharmaceuticals, Inc. The patient must present a valid prescription for Oxtellar XR® (oxcarbazepine) extended-release tablets when redeeming this card. Prescriber ID# required on prescription. This card is valid towards out-of-pocket expenses for Oxtellar XR®. If the patient’s total cost per prescription is more than $0, this program will cover the amount above $0 (up to a maximum of $250 per prescription) on each of the next 12 prescriptions for up to a 30-day supply of Oxtellar XR® of any dosage strength filled. Patients with questions please call 1-866-398-0833.

Pharmacist instructions for a patient with an Eligible Third Party: When you use this card, you are certifying that you have not submitted and will not submit a claim for reimbursement under any federal, state or other governmental programs for this prescription.

  • Submit transaction to McKesson Corporation using BIN #610524.
  • If primary commercial prescription insurance exists, input card information as secondary coverage and transmit using the COB segment of the NCPDP transaction. Applicable discounts will be displayed in the transaction response.
  • Acceptance of this card and your submission of claims for the Oxtellar XR® program are subject to the LoyaltyScript® program Terms and Conditions posted at www.mckesson.com/mprstnc.
  • Patient is not eligible if prescriptions are paid in part or full by any state or federally funded programs, including but not limited to Medicare or Medicaid, Medigap, VA, DOD or TriCare and where prohibited by law.
  • For questions regarding setup, claim transmission, patient eligibility or other issues, call the LoyaltyScript® for Oxtellar XR® program at 877-264-2440 (8:00 AM-8:00 PM EST, Monday-Friday).

Supernus reserves the right to rescind, revoke, or amend this offer without notice at any time.

Limit one card per patient. Offer not valid for prescriptions reimbursed under Medicaid, a Medicare drug benefit plan or other federal or state programs (such as medical assistance programs). If you are eligible for drug benefits under any such program, you cannot use this card.

Oxtellar XR® (oxcarbazepine) extended-release tablets for oral use

INDICATION

Oxtellar XR® (oxcarbazepine) extended-release tablets is a prescription medicine used with other medicines to treat partial seizures in adults and children 6 to 17 years of age.

Important Safety Information

Do not take Oxtellar XR if you are allergic to oxcarbazepine or any of the other ingredients in Oxtellar XR.

Oxtellar XR can cause serious side effects, including a low level of sodium in your blood. Symptoms of low blood sodium include nausea, tiredness, lack of energy, headache, confusion, and more frequent or more severe seizures. Similar symptoms that are not related to low sodium may occur from taking Oxtellar XR. Other serious side effects include seizures happening more often or becoming worse, trouble concentrating, problems with your speech and language, feeling confused, feeling sleepy and tired, and trouble walking and with coordination. The most common side effects include dizziness, sleepiness, headache, problems with walking and coordination (unsteadiness), shakiness, nausea, vomiting, double vision, weakness, and tiredness. These are not all of the possible side effects of Oxtellar XR. For more information, ask your healthcare provider or pharmacist.

Like other antiepileptic drugs, Oxtellar XR may cause suicidal thoughts or actions in a very small number of people, about 1 in 500. Before you take Oxtellar XR, tell your healthcare provider if you have or have had depression, mood problems, or suicidal thoughts or behavior. Call a healthcare provider right away if you have thoughts about suicide or dying, attempts to commit suicide, have new or worse depression or new or worse anxiety, feel agitated or restless, experience panic attacks, trouble sleeping (insomnia), or new or worse irritability, feel or act more aggressive, angry, or violent, act on dangerous impulses, have an extreme increase in activity and talking (mania), or experience other unusual changes in behavior or mood.

Oxtellar XR may also cause allergic reactions or serious problems which may affect organs and other parts of your body like the liver or blood cells. You may or may not have a rash with these types of reactions. Call your healthcare provider right away if you have any of the following: swelling of your face, eyes, lips, or tongue, trouble swallowing or breathing, a skin rash, hives, fever, swollen glands, or sore throat that does not go away or comes and goes, painful sores in the mouth or around your eyes, yellowing of your skin or eyes, unusual bruising or bleeding, severe fatigue or weakness, severe muscle pain, frequent infections, or infections that do not go away. Many people who are allergic to carbamazepine are also allergic to Oxtellar XR. Tell your healthcare provider if you are allergic to carbamazepine.

Before taking Oxtellar XR, tell your healthcare provider about all your medical conditions, including if you have or have had suicidal thoughts or actions, depression or mood problems, have liver problems, have kidney problems, use birth control medicine, are pregnant or plan to become pregnant, or are breastfeeding or plan to breastfeed. Oxtellar XR passes into breast milk. You and your healthcare provider should discuss whether you should take Oxtellar XR or breastfeed. You should not do both.

Oxtellar XR may harm your unborn baby. Tell your healthcare provider right away if you become pregnant while taking Oxtellar XR. If you use birth control medicine, Oxtellar XR may cause your birth control medicine to be less effective.

Tell your healthcare provider about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Taking Oxtellar XR with certain other medicines may cause side effects or affect how well they work. Do not start or stop other medicines without talking to your healthcare provider. Especially tell your healthcare provider if you take: carbamazepine, phenobarbital, phenytoin, or birth control medicine.

Do not stop taking Oxtellar XR without talking to your healthcare provider. Stopping Oxtellar XR suddenly can cause serious problems, including seizures that will not stop. Take Oxtellar XR exactly as prescribed.

Do not drive, operate heavy machinery, or do other dangerous activities until you know how Oxtellar XR affects you. Oxtellar XR may slow your thinking and motor skills.

Do not drink alcohol or take other drugs that make you sleepy or dizzy while taking Oxtellar XR until you talk to your healthcare provider. Oxtellar XR taken with alcohol or drugs that cause sleepiness or dizziness may make your sleepiness or dizziness worse.

Please refer to the Medication Guide for additional important patient information.
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.

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Oxtellar XR is a registered trademark of Supernus Pharmaceuticals, Inc.
All other trademarks are the property of their respective owners.
©2017 Supernus Pharmaceuticals, Inc. All rights reserved. SPN.OXT.2017-0034