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ZENPEP Savings Program

For patients with exocrine pancreatic insufficiency (EPI) due to other conditions

You may be able to save on out-of-pocket costs for a ZENPEP prescription and more by signing up for the ZENPEP Patient Savings Program.* Eligible patients may receive reduced out of pocket costs on their Zenpep prescriptions, free vitamins or supplements, refill and dosage administration reminders, and
live support from customer care advocates.

As a member of the program, you’ll receive the ZENPEP Savings Card. With the savings card, eligible
patients may pay as low as $0 per prescription fill.*

For illustrative purposes only.

You’ll also receive free vitamins or supplements with a cost savings. This offering includes:

*This offer is valid only for patients with ZENPEP prescriptions. Eligible patients may pay as low as $0 per ZENPEP 30-day prescription fill; up to 12 fills. Check with pharmacist for copay discount. Maximum savings limit applies; patient out-of-pocket expense may vary. Offer not valid for patients enrolled in Medicare, Medicaid, or other federal or state healthcare programs. Please see Program Terms, Conditions, and Eligibility Criteria here or on back of card.

Step 1: Authorization

AUTHORIZATION FOR USE AND RELEASE OF PROTECTED HEALTH INFORMATION

ZENPEP® Patient Savings Program

I authorize Allergan and its contractors and business partners (“Allergan”) to use and/or disclose my personal information, including my personal health information, for the following purposes: (1) to operate, administer, enroll me in, and/or continue my participation in the ZENPEP Patient Savings Program and/or any other Allergan-affiliated patient support services and activities related to my condition or treatment (for example, co-pay card programs if eligible, reimbursement assistance programs, drug coverage verification, healthcare provider educator services, adherence programs, and disease management support); (2) to provide me with informational and promotional materials relating to Allergan products and services, and/or my condition or treatment; and/or (3) to improve, develop, evaluate, and continue Allergan products, services, materials, and programs related to my condition or treatment.

In order for Allergan to provide the above services and programs to me, I understand that Allergan will need my personal information and my health information, which may include my name, address, email address, information about my health condition, my treatment and product information, treatment dates, eligible treatment type, my medical history and general health, my healthcare plan benefits and coverage, information about my adherence to my treatment, and other relevant personal and health information (“Personal Health Information”). I authorize my healthcare providers, including my doctor’s office, pharmacies, health plans, laboratory services, and other healthcare providers, and all employees, individuals, and entities working with or for such healthcare providers (“Healthcare Providers”) who have my Personal Health Information to release and disclose my Personal Health Information to Allergan only for the purposes set forth above, including providing me with the ZENPEP Patient Savings Program.

I understand that some of my Healthcare Providers (such as pharmacies and specialty pharmacies) may receive remuneration from Allergan in exchange for disclosing my Personal Health Information and/or for using my information to contact me with communications about Allergan products that have been prescribed to me and other patient support services.

My Healthcare Providers may release my Personal Health Information in whatever form and through whatever media, including the internet, as required by the purposes set forth.

I further understand that once my Healthcare Providers disclose my Personal Health Information to Allergan, it may no longer be covered by federal privacy regulations, and, therefore, could be re-disclosed. However, Allergan agrees to protect my Personal Health Information by only using and disclosing it as stated in this Authorization or as otherwise allowed or required by law.

I understand that I may receive a copy of this authorization or revoke this authorization at any time by calling (866) 800-8082. However, if I revoke this authorization, I understand I may no longer qualify for the ZENPEP Patient Savings Program and/or the other services described above. I further understand that if a Healthcare Provider is disclosing my Personal Health Information to Allergan, my revocation of this authorization will only prevent further disclosure of my Personal Health Information to Allergan by such Healthcare Providers after they receive notice of my revocation.

I understand that this authorization is voluntary and I may refuse to sign it. My refusal to sign will not affect my ability to obtain treatment or payment for my treatment. But, I may be ineligible to qualify for the ZENPEP Patient Savings Program and the other programs and services set forth above.

I understand that this authorization for my Healthcare Providers to disclose my Personal Health Information will not expire unless I notify Allergan to terminate it, or unless another date is specified herein, or is required by state or other applicable law(s).

Electronic Authorization:

I understand that by clicking the “I accept” button below, that I am consenting electronically and providing legal authorization for Allergan, including any affiliates, subcontractors, and/or agents of Allergan (such as vendors operating the ZENPEP Patient Savings Program) to use and share, and for my Healthcare Providers to disclose, my Personal Health Information for the purposes described within the above authorization. I am also indicating that I am at least 18 years old and either the patient or legal guardian of the patient by clicking the “I accept” button.

I accept

Step 2: Registration and activation










Gender

Are you a resident of the United States or Puerto Rico?

Do you have commercial prescription drug insurance?

Do you currently have a ZENPEP Savings Card?

Vitamin or Supplement Selection

By selecting the vitamin or supplement option below, I acknowledge that a physician has been consulted about the vitamins offered through the ZENPEP Patient Savings Program.

Select your preferred method of contact



Email Updates

By providing your email address, you agree that you would like to receive information from Allergan related to ZENPEP and the ZENPEP Patient Savings Program, including site updates, education, and other Allergan products and services. The information pertaining to you that we collect will be used in accordance with our Privacy Statement. If you later wish to opt out from receiving this information, you may click on the included opt-out link in future communications.

By activating the card and enrolling in the Patient Savings Program, you certify you have commercial prescription drug insurance and are not enrolled in a federal- or state-funded prescription drug benefit program, such as Medicare, Medicaid, or any private indemnity or HMO insurance plan that reimburses you for the entire cost of your prescription drugs. You also certify that you are not Medicare-eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees. You further certify that should you begin receiving prescription benefits from one of these types of programs at any time, you will no longer participate in the savings program.

I agree to this certification and accept the Program Terms, Conditions and Eligibility Criteria available here or on back of card.

Step 3: Confirmation

Congratulations!

Your registration in the ZENPEP Patient Savings Program is now complete and your Savings Card is active and ready to use. Use the following link to download and print your Savings Card. Please remember to provide your pharmacist with the card every time you fill your ZENPEP prescription. If you have any questions or issues regarding use of your card, please call us at 1.855.706.8717. For product information on the vitamins provided, please download the Vitamin Fact Sheet.

Allergan corporate policy prohibits the downloading, printing and/or acceptance of savings cards by licensed healthcare professionals who regularly practice in Vermont.

These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

§Vitamins should be taken as directed on label or otherwise directed by a physician. Actual product, packaging, and materials may vary and are subject to substitution or replacement at any time. Always read labels, warnings, and directions before using or consuming a product.

Trademarks are owned by their respective companies.

ZENPEP resources

Patient brochure

Download the ZENPEP brochure for patients or caretakers who want to learn about EPI.

IMPORTANT RISK INFORMATION

What is the most important information I should know about ZENPEP?
ZENPEP® (pancrelipase) may increase your chance of having a rare bowel disorder called fibrosing colonopathy. This condition is serious and may require surgery. The risk of having fibrosing colonopathy may be reduced by following the dosing instructions your doctor gave you. Call your doctor right away if you have any unusual or severe: stomach area (abdominal) pain, bloating, trouble passing stool (having bowel movements), nausea, vomiting, or diarrhea.
Take ZENPEP exactly as prescribed. Do not take more or less ZENPEP than directed by your doctor.
Before you take ZENPEP, tell your doctor:
If you are allergic to pork (pig) products; have a history of blockage of your intestines, or scarring or thickening of your bowel wall (fibrosing colonopathy); have gout, kidney disease, or high blood uric acid (hyperuricemia); have trouble swallowing capsules; have any other medical condition; are pregnant or plan to become pregnant; are breastfeeding or plan to breastfeed.
About all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.
How should I take ZENPEP?
Take ZENPEP exactly as your doctor tells you.
Do not crush or chew the ZENPEP capsule or its contents, and do not hold the capsule or contents in your mouth. This may cause irritation in your mouth or change the way ZENPEP works in your body. See Patient Medication Guide and talk to your doctor for additional directions.
Side Effects
ZENPEP may cause serious side effects, including worsening of swollen, painful joints (gout) caused by an increase in blood uric acid levels and allergic reactions including trouble with breathing, skin rashes, or swollen lips. Call your doctor right away if you have any of these symptoms.
The most common side effects of ZENPEP include belly pain, gas, and headache.
ZENPEP and other pancreatic enzyme products are made from the pancreas of pigs, the same pigs people eat as pork. These pigs may carry viruses. Although it has never been reported, it may be possible for a person to get a viral infection from taking pancreatic enzyme products that come from pigs.
Tell your doctor if you have any side effect that bothers you or does not go away. These are not all the possible side effects of ZENPEP.
For more information, ask your doctor or pharmacist.
What is ZENPEP?
ZENPEP is a prescription medicine for people who cannot digest food normally because their pancreas does not make enough enzymes. ZENPEP may help your body use fats, proteins, and sugars from food. ZENPEP contains a mixture of digestive enzymes (lipases, proteases, and amylases) from pig pancreas. ZENPEP is safe and effective in children.
Please also see Patient Medication Guide within the full Prescribing Information

IMPORTANT RISK INFORMATION

What is the most important information I should know about ZENPEP?
ZENPEP® (pancrelipase) may increase your chance of having a rare bowel disorder called fibrosing colonopathy. This condition is serious and may require surgery. The risk of having fibrosing colonopathy may be reduced by following the dosing instructions your doctor gave you. Call your doctor right away if you have any unusual or severe: stomach area (abdominal) pain, bloating, trouble passing stool (having bowel movements), nausea, vomiting, or diarrhea.
Take ZENPEP exactly as prescribed. Do not take more or less ZENPEP than directed by your doctor.
Before you take ZENPEP, tell your doctor:
If you are allergic to pork (pig) products; have a history of blockage of your intestines, or scarring or thickening of your bowel wall (fibrosing colonopathy); have gout, kidney disease, or high blood uric acid (hyperuricemia); have trouble swallowing capsules; have any other medical condition; are pregnant or plan to become pregnant; are breastfeeding or plan to breastfeed.
About all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.
How should I take ZENPEP?
Take ZENPEP exactly as your doctor tells you.
Do not crush or chew the ZENPEP capsule or its contents, and do not hold the capsule or contents in your mouth. This may cause irritation in your mouth or change the way ZENPEP works in your body. See Patient Medication Guide and talk to your doctor for additional directions.
Side Effects
ZENPEP may cause serious side effects, including worsening of swollen, painful joints (gout) caused by an increase in blood uric acid levels and allergic reactions including trouble with breathing, skin rashes, or swollen lips. Call your doctor right away if you have any of these symptoms.
The most common side effects of ZENPEP include belly pain, gas, and headache.
ZENPEP and other pancreatic enzyme products are made from the pancreas of pigs, the same pigs people eat as pork. These pigs may carry viruses. Although it has never been reported, it may be possible for a person to get a viral infection from taking pancreatic enzyme products that come from pigs.
Tell your doctor if you have any side effect that bothers you or does not go away. These are not all the possible side effects of ZENPEP.
For more information, ask your doctor or pharmacist.
What is ZENPEP?
ZENPEP is a prescription medicine for people who cannot digest food normally because their pancreas does not make enough enzymes. ZENPEP may help your body use fats, proteins, and sugars from food. ZENPEP contains a mixture of digestive enzymes (lipases, proteases, and amylases) from pig pancreas. ZENPEP is safe and effective in children.
Please also see Patient Medication Guide within the full Prescribing Information.