For adult males with low testosterone
due to a certain medical condition
WE’VE GOT YOU COVERED

If you have a commercial prescription insurance plan,
Androderm® offers a convenient, digital Savings Card*† to
offset the cost of your prescription. Here’s how it works.
Savings will apply after you pay up to the first $30.
Maximum Savings Card benefit is $50.
So if your copay is
more than $80, Allergan will contribute $50 via the Savings
Card, but you are responsible for the remaining amount.

Get your ANDRODERM® Savings Card

Once you fill out this form, you’ll get your card right away! A copy will also be sent to your email address, in case you can’t print your Savings Card immediately. When you’re ready, simply print it out and use it next time you fill your prescription.

First Name
Last Name
Zip Code
Date of Birth
Email
Verify Email

Your use of the Androderm® Savings Card constitutes acceptance of the following Terms and Conditions:

The information pertaining to you that we collect will be used in accordance with our Privacy Policy. Your personal information will not be shared with anyone.

I agree to receive marketing information, offers, refill reminders, and promotions regarding men’s healthcare. I understand that the information that I provide will be used in accordance with the above Privacy Policy. I understand that unless I unsubscribe, my consent will remain valid.

Offer not valid for prescriptions reimbursed in full, or in part, under Medicare, Medicaid, TriCare, or any similar federal or state programs (including pharmaceutical assistance programs), or private indemnity or HMO insurance plans that reimburse you for the entire cost of your prescription drugs. Patients may not use this card if they are Medicare-eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees. This is not insurance.

By using the offer, you agree that you will not submit a claim for the prescription to a government payor. This offer is only valid in the United States. This offer is void where prohibited by law. The card is not transferable and the amount of the rebate cannot exceed the patient’s out-of-pocket expenses. If any part of your prescription is paid for by a non-governmental third-party payor, you attest to having disclosed this offer to your third-party payor. By using this offer, you are consenting to the collection and use of certain personal information including your phone number and elements of pharmacy claim information. This information will be collected and used by service providers of Allergan, Inc. ("Allergan") in order to administer this program. This information is not provided to Allergan directly. If you do not consent, please do not use this offer. If you require additional assistance, please call 1-855-497-8464.

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

By clicking this box you acknowledge that you are an eligible insured patient and that you understand and agree to comply with the terms and conditions of this offer.

Click submit if you accept the terms and conditions to receive the Androderm® Savings Card and communications about Androderm®.

Congratulations!

You have successfully registered for a Savings Card!

Your card is now ready for use. We have emailed you a copy of your Androderm® Savings Card. Start saving today by bringing this Savings Card along with your Androderm® prescription to the pharmacy.† The Androderm® Savings Card can be used at most pharmacies. If you experience any difficulty using the card, please call 1‑855‑285‑8115.

*Terms and conditions apply.

† Savings will apply after eligible insured patients pay the first $30. Maximum Savings Card benefit is $50.

‡ Prescriber ID# required on prescription. This offer is not valid for prescriptions covered by or submitted for reimbursement under Medicaid, Medicare, or similar federal or state programs (including any state medical pharmaceutical assistance program), or private indemnity or HMO insurance plans that reimburse you for the entire cost of your prescription drugs. Patients may not use this card if they are Medicare-eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees. This offer is not valid for those under 18 years of age. Valid for patients with private insurance only. Offer valid for up to 13 uses. This is not insurance. Allergan reserves the right to rescind, revoke, or amend this offer without notice at any time. Offer expires 12/31/2016.

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IMPORTANT RISK INFORMATION

Who should not use ANDRODERM®?

Do not use ANDRODERM if you:

INDICATION

ANDRODERM is a prescription medicine that contains testosterone. ANDRODERM is used to treat adult males who have low or no testosterone due to primary hypogonadism or hypogonadotropic hypogonadism.

It is not known if ANDRODERM is safe and effective to treat men who have low testosterone due to aging.

It is not known if ANDRODERM is safe and effective in children younger than 18 years old. Improper use of ANDRODERM may affect bone growth in children.

IMPORTANT RISK INFORMATION (cont’d)

What should I tell my healthcare provider before using ANDRODERM?

Before you use ANDRODERM, tell your healthcare provider if you:

Tell your healthcare provider about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.

Using ANDRODERM with other medicines can affect how ANDRODERM works and how the other medicines work. Especially, tell your healthcare provider if you take:

What are the possible side effects of ANDRODERM?

ANDRODERM can cause serious side effects including:

Call your healthcare provider right away if you have any of the serious side effects listed above.

The most common side effects of ANDRODERM include:

Other side effects include more erections than are normal for you or erections that last a long time.

Tell your healthcare provider if you have any side effect that bothers you or that does not go away. These are not all the possible side effects of ANDRODERM.

Please see full Prescribing Information.

See more

IMPORTANT RISK INFORMATION

Who should not use ANDRODERM®?

Do not use ANDRODERM if you:

  • are a man who has breast cancer
  • have or might have prostate cancer
  • are pregnant or may become pregnant or are breastfeeding. ANDRODERM may harm your unborn or breastfeeding baby

INDICATION

ANDRODERM is a prescription medicine that contains testosterone. ANDRODERM is used to treat adult males who have low or no testosterone due to primary hypogonadism or hypogonadotropic hypogonadism.

It is not known if ANDRODERM is safe and effective to treat men who have low testosterone due to aging.

It is not known if ANDRODERM is safe and effective in children younger than 18 years old. Improper use of ANDRODERM may affect bone growth in children.

IMPORTANT RISK INFORMATION (cont’d)

What should I tell my healthcare provider before using ANDRODERM?

Before you use ANDRODERM, tell your healthcare provider if you:

  • have breast cancer
  • have or might have prostate cancer
  • have urinary problems due to an enlarged prostate
  • have heart problems
  • have kidney or liver problems
  • have problems breathing while you sleep (sleep apnea)
  • have diabetes
  • have any other medical conditions

Tell your healthcare provider about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.

Using ANDRODERM with other medicines can affect how ANDRODERM works and how the other medicines work. Especially, tell your healthcare provider if you take:

  • insulin
  • medicines that decrease blood clotting
  • corticosteroids

What are the possible side effects of ANDRODERM?

ANDRODERM can cause serious side effects including:

  • If you already have an enlargement of your prostate gland your signs and symptoms may get worse while using ANDRODERM. This can include:
    • increased urination at night
    • ­
    • trouble starting your urine stream
    • ­
    • having to pass urine many times during the day
    • ­
    • having an urge that you have to go to the bathroom right away
    • ­
    • having a urine accident
    • ­
    • being unable to pass urine or weak urine flow
  • Possible increased risk of prostate cancer. Your healthcare provider should check you for prostate cancer or any other prostate problems before you start and while you use ANDRODERM.
  • Blood clots in the legs or lungs. Signs and symptoms can include leg pain, swelling or redness of your legs, difficulty breathing or chest pain.
  • Possible increased risk of heart attack or stroke.
  • In large doses ANDRODERM may lower your sperm count.
  • Swelling of your ankles, feet, or body, with or without heart failure.
  • Enlarged or painful breasts.
  • Problems breathing while you sleep (sleep apnea).

Call your healthcare provider right away if you have any of the serious side effects listed above.

The most common side effects of ANDRODERM include:

  • skin redness, irritation, burning, or blisters where ANDRODERM is applied
  • back pain
  • depression
  • headache
  • prostate abnormalities

Other side effects include more erections than are normal for you or erections that last a long time.

Tell your healthcare provider if you have any side effect that bothers you or that does not go away. These are not all the possible side effects of ANDRODERM.

Please see full Prescribing Information.