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ONGLYZA & KOMBIGLYZE Savings Card Image
Request Your CardMail Order Rebate
 
 

TO USE IN MAIL ORDER OR NON-PARTICIPATING PHARMACIES

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Onglyza LogoKombiglyze XR Logo

The savings card for ONGLYZA and KOMBIGLYZE XR

If your mail order pharmacy does not accept the savings card, follow these simple steps after activating your card:

  1. Call your mail order pharmacy to see if they accept the savings card. If they do, provide them with your savings card ID number after they receive your prescription. You will receive your check when the pharmacy processes your prescription payment.

  2. If your mail order or retail pharmacy does NOT accept the savings card:

    • Call 1-844-381-63011-844-381-6301 to request a patient rebate form, or go to www.mysavingsupport.com/rebate to download a form.

    • When you receive this form, complete and sign it. Then mail this form along with the original mail-order pharmacy receipt (cash register receipts are not acceptable) to the address listed on the form. Forms submitted without the original mail-order pharmacy receipt will not be valid and therefore will not be eligible for reimbursement.

    • Remember to keep a copy of your receipt for your records. You should receive your check in about 6 to 8 weeks.

  3. You will need to submit a patient rebate form each time you get a refill of your prescription and complete step 2B to receive your check.

Please click here for Medication Guide, and click here for Prescribing Information for ONGLYZA.

Please click here for Medication Guide, and click here for Prescribing Information, including Boxed WARNING about lactic acidosis for KOMBIGLYZE XR (5/500•5/1000•2.5/1000 mg tablets).

KOMBIGLYZE XR logo
 

The savings card for ONGLYZA and KOMBIGLYZE XR is now part of AZhelps

Now you can:

  • Save with copays as little as [$0]with commercial insurance*
  • Access your savings card on your mobile phone
  • Take advantage of savings on other participating AstraZeneca medications

Activate your AZhelps Savings Card* today and add it to [Apple Passbook on your iPhone][Android Pay on your smartphone].

Commercially insured patients can still save, with copays as little as [$0]

*Subject to eligibility. Restrictions apply. See below for details.

If eligible, show your card and prescription to your pharmacist for instant savings.

CO-PAYs AS LITTLE AS

$0*

For commercially insured patients

If you are a commercially insured patient, you may get ONGLYZA or KOMBIGLYZE XR for as low as $0 per month* for as long as your doctor prescribes any available dose.

*Subject to eligibility. Restrictions apply.
Not available for government-insured patients.