SUBOXONE® (buprenorphine and naloxone) Sublingual Film (CIII)
Please see Important Safety Information on next page, and full Product Information and Medication Guide for SUBOXONE Film at suboxone.com
Pharmacist for a cash-paying patient: Submit this claim to Therapy First. A valid Other Coverage Code is required. The patient pay amount will be reduced by up to $75 per prescription filled and you will receive this in your reimbursement from Therapy First plus a handling fee.
Pharmacist for a patient with an Authorized Third Party: Submit the claim to the primary Third-Party Payer first, then submit the balance due to Therapy First as a Secondary Payer as a copay only billing using Other Coverage Code of 8. The patient pay amount will be reduced by up to $75 per prescription filled and you will receive this in your reimbursement from Therapy First plus a handling fee.
Other Coverage Code required: For any questions regarding Therapy First online processing, please call the Help Desk at 1-800-422-5604.
* This savings program covers up to $75 of your out-of-pocket expenses on each SUBOXONE Film prescription you fill through March 31, 2011 (limit 1 prescription per month). Savings on each prescription filled cannot exceed amount of copay. You may take advantage of only one savings offer from Reckitt Benckiser Pharmaceuticals Inc. at any one time.
This offer is not valid for SUBOXONE prescriptions covered under Medicare, Medicaid, TRICARE, or other federal or state assistance programs. Patients enrolled in the Reckitt Benckiser Pharmaceuticals Patient Assistance Program are not eligible to receive this offer. Offer void in Massachusetts. Void where prohibited by law, taxed, or otherwise restricted. The selling, purchasing, trading, or counterfeiting of savings cards is prohibited by law. Offer valid only at participating retail pharmacies in the US.
Limit 1 prescription per month and valid only in the USA. Offer expires March 31, 2011. Reckitt Benckiser Pharmaceuticals reserves the right to rescind, revoke, or amend this offer without notice.
Your offer has its own unique ID number. You can’t transfer it or provide a copy to another person; only you can use it. If you lose your offer before the first time you use it, simply print out a new copy at SuboxoneFilmSavings.com and bring it to the pharmacy. If you lose your offer after the first time you use it, tell your pharmacist so he or she can validate the transaction.
SUBOXONE® (buprenorphine and naloxone) Sublingual Film (CIII) is indicated for maintenance treatment of opioid dependence as part of a complete treatment plan to include counseling and psychosocial support. Treatment should be initiated under the direction of physicians qualified under the Drug Addiction Treatment Act.
SUBOXONE Sublingual Film should not be used by patients hypersensitive to buprenorphine or naloxone.
SUBOXONE Sublingual Film can be abused in a manner similar to other opioids, legal or illicit. Clinical monitoring appropriate to the patient’s level of stability is essential. Chronic use of buprenorphine can cause physical dependence. A sudden or rapid decrease in dose may result in
an opioid withdrawal syndrome that is typically milder than seen with full agonists and may be delayed in onset. SUBOXONE Sublingual Film can cause serious life-threatening respiratory depression and death, particularly when taken by the intravenous (IV) route in combination with benzodiazepines or other central nervous system (CNS) depressants (ie, sedatives, tranquilizers, or alcohol). It is extremely dangerous to self-administer nonprescribed
benzodiazepines or other CNS depressants while taking SUBOXONE Sublingual Film. Dose reduction of CNS depressants, SUBOXONE Sublingual Film, or both when both are being taken should be considered. Liver function should be monitored before and during treatment. Death has been reported in nontolerant, nondependent individuals, especially in the presence of CNS
Children who take SUBOXONE Sublingual Film can have severe, possibly fatal, respiratory depression. Emergency medical care is critical. Keep SUBOXONE Sublingual Film out of the sight and reach of children. Intravenous misuse or taking SUBOXONE Sublingual Film before the effects of full-agonist opioids (eg, heroin,
hydrocodone, methadone, morphine, oxycodone) have subsided is highly likely to cause opioid withdrawal
symptoms. Neonatal withdrawal has been reported. Use of SUBOXONE Sublingual Film in pregnant women or during breast-feeding should only be considered if the potential benefit justifies the potential risk. Caution should be exercised when driving vehicles or operating hazardous machinery, especially during dose adjustment.
Adverse events commonly observed with the sublingual administration of SUBOXONE Sublingual Film are numb mouth, sore tongue, redness of the mouth, headache, nausea, vomiting, sweating, constipation, signs and symptoms of withdrawal, insomnia, pain, swelling of the limbs, disturbance of attention, palpitations, and blurred vision.
Cytolytic hepatitis, jaundice, and allergic reactions, including anaphylactic shock, have been reported.
This is not a complete list of potential adverse events associated with SUBOXONE Sublingual Film. Please see full Product Information for a complete list. To report an adverse event associated with taking SUBOXONE Sublingual Film, please call 1-877-782-6966.
You are encouraged to report adverse events of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Please see full Product Information and Medication Guide for SUBOXONE Film at suboxone.com
SUBOXONE® is a registered trademark of Reckitt Benckiser Healthcare (UK) Ltd. Manufactured for Reckitt Benckiser Pharmaceuticals Inc., Richmond, VA 23235 by MonoSol Rx LLC, Warren, NJ 07059 Copyright © 2010 Reckitt Benckiser Pharmaceuticals Inc. 09/10