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  1. FREE TRIAL OFFER* FOR ELIGIBLE PATIENTS. • Eligible patients of the Free Trial Offer will receive one 30-day supply FREE* *Subject to eligibility rules; restrictions apply. For Medicare Part D, Medicaid or Cash-Paying Patients. RECEIVE A 30-DAY SUPPLY OF FARXIGA®.

  2. A resource to help physicians, advocates, and patients access free medications through pharmaceutical company patient assistance programs.

  3. You will pay a set amount of your out-of-pocket costs, based on the product, and your pharmacy or healthcare provider will submit a claim to the Patient Savings Program to cover the balance, up to the program maximum. See details below.

  4. The list price for FARXIGA is $582.25 † for a 30-day supply. The information below may help you estimate your cost for FARXIGA based on your insurance, but your insurance provider can provide more specific information. Insurance type: Employer-provided or individual private policy.

  5. AstraZeneca is committed to helping those who can’t afford BREZTRI. If you have employer-provided or individual private (commercial) insurance, you may be able to get BREZTRI for as low as $0 § with the BREZTRI Zero Pay Card.

  6. DOWNLOAD SAVINGS CARD. *Eligible commercially insured patients can get FARXIGA for as low as $0 as long as their doctor prescribes it. For Mail Order: Call the number on the card and ask for Customer Service, or click here to download the mail-in rebate form.

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