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This offer can be used for up to a total of 12 30-day fills per calendar year, with an aggregate maximum savings cap of $6,600 per calendar year.įormoterol Fumarate Inhalation Solution (the authorized generic to PERFOROMIST (formoterol fumarate) Inhalation Solution): Out-of-pocket costs for Formoterol Fumarate Inhalation Solution may be covered up to a maximum of $25 per 30-day prescription. PERFOROMIST (formoterol fumarate) Inhalation Solution: Out-of-pocket costs for PERFOROMIST may be covered up to a maximum of $550 per 30-day prescription. Mylan Specialty L.P., a Viatris Company, reserves the right to amend or end this program at any time without notice. Valid prescription with Prescriber ID# is required. This Savings Card may be used to reduce the amount of your out-of-pocket costs for select Viatris products identified below up to the applicable maximum savings amount as described below while this program remains in effect. PERFOROMIST ® (formoterol fumarate) Inhalation Solution and Formoterol Fumarate Inhalation Solution Savings Card Terms and Conditions

Please select one of the below options to proceed. Valid prescription with Prescriber ID# required. This offerĬan be used up to a total of 12 30-days fills per calendar year, with a maximum savings cap of $300 per calendar year while this program remains in effect. PERFOROMIST (formoterol fumarate) Inhalation Solution):įor eligible commercially insured patients, this Savings Card may be used to reduce the amount of their out-of-pocket costs for Formoterol Fumarate Inhalation Solution up to a maximum of $25 per 30-day prescription. This offer can be used up to a total of 12 30-days fills per calendar year, with a maximum savings cap of $6,600 per calendar year while this program remains in effect.įormoterol Fumarate Inhalation Solution (the authorized generic to PERFOROMIST (formoterol fumarate) Inhalation Solution:įor eligible commercially insured patients, this Savings Card may be used to reduce the amount of their out-of-pocket costs for PERFOROMIST up to a maximum of $550 per 30-day prescription. What is the PERFOROMIST and Formoterol Fumarate Inhalation Solution Savings Card?