Valid For: Humalog KwikPen, Humalog Mix75/25 KwikPen, Humalog Mix50/50 KwikPen, Humalog cartridge or vial, Humalog Mix75/25 vial, or Humalog Mix50/50 vial.
Patient: Redeem at local retail pharmacy.
Pharmacist: By accepting this offer you certify that you understand and agree to comply with the offer terms set forth herein. Submit claim to OPTUMRx. Processor requires Valid Prescriber ID#, Patient Name, and DOB for claim adjudication. For assistance call 1-800-510-4836.
Limit: One (1) voucher per patient per 12 month period across all Humalog programs.
THIS OFFER MAY BE TERMINATED, RESCINDED, REVOKED, OR AMENDED BY LILLY USA, LLC AT ANY TIME.
|OFFER TERMS: VOID WHERE PROHIBITED BY LAW. PRODUCT DISPENSED AS SAMPLE PURSUANT TO THE TERMS OF THIS VOUCHER SHALL NOT BE SUBMITTED TO ANY THIRD-PARTY PAYER, PUBLIC OR PRIVATE (E.G., MEDICAID, MEDICARE, PRIVATE INSURANCE, ANY GOVERNMENTAL PROGRAM, AND ANY OTHER FEDERAL OR STATE PROGRAM SUCH AS CHAMPUS, THE VA, TRICARE, OR A STATE PHARMACEUTICAL ASSISTANCE PROGRAM) FOR REIMBURSEMENT. OFFER CANNOT BE COMBINED WITH ANY OTHER FREE TRIAL, COUPON, REBATE, OR SIMILAR OFFER. BY ACCEPTING THIS VOUCHER, THE PHARMACIST CERTIFIES THAT (1) HUMALOG®, HUMALOG® KWIKPEN®, HUMALOG® MIX75/25™, HUMALOG® MIX50/50™, HUMALOG® MIX75/25™ KWIKPEN®, OR HUMALOG® MIX50/50™ KWIKPEN® HAS BEEN DISPENSED TO AN ELIGIBLE PATIENT PURSUANT TO A VALID PRESCRIPTION FOR HUMALOG, HUMALOG KWIKPEN, HUMALOG MIX75/25, HUMALOG MIX50/50, HUMALOG MIX75/25 KWIKPEN, OR HUMALOG MIX50/50 KWIKPEN; (2) NO CLAIM HAS BEEN SUBMITTED FOR REIMBURSEMENT TO THE PATIENT OR ANY THIRD-PARTY PAYER; AND (3) PARTICIPATION IN THIS PROGRAM COMPLIES WITH ALL APPLICABLE LAWS AND CONTRACTUAL OR OTHER OBLIGATIONS AS A PHARMACY PROVIDER. IT IS ILLEGAL FOR ANY PERSON TO SELL, PURCHASE, OR TRADE; OR TO OFFER TO SELL, PURCHASE, OR TRADE OR TO COUNTERFEIT THIS VOUCHER. THIS OFFER IS VALID FOR US (AND PR IF APPLICABLE) RESIDENTS ONLY. LILLY USA, LLC RESERVES THE RIGHT TO RESCIND, REVOKE OR AMEND THIS PROGRAM/OFFER WITHOUT NOTICE AT ANY TIME. USE OF THIS CARD DOES NOT CREATE ANY OBLIGATION OR INVOLVE ANY PAST OR FUTURE PURCHASE REQUIREMENT. NO PURCHASE REQUIRED. YOU UNDERSTAND AND AGREE TO COMPLY WITH THESE OFFER TERMS.
HI91339 07/2014 PRINTED IN USA ©Lilly USA, LLC 2014. ALL RIGHTS RESERVED. Humalog® and Humalog® KwikPen® are registered trademarks of Eli Lilly and Company and are available by prescription only. Humalog® Mix75/25™, Humalog® Mix50/50™, Humalog® Mix75/25™ KwikPen®, and Humalog® Mix50/50™ KwikPen® are trademarks of Eli Lilly and Company and are available by prescription only.
Important Safety Information for Humalog®, Humalog® Mix75/25™, and Humalog® Mix50/50™
What is the most important information I should know about Humalog, Humalog Mix75/25, and Humalog Mix50/50?
- Do not change the insulin you use without talking to your healthcare provider. Doses of oral antidiabetic medicines may also need to change if your insulin is changed.
- Test your blood sugar levels as your healthcare provider instructs.
- When used in a pump, do not mix Humalog with any other insulin or liquid. Never use Humalog Mix75/25 or Humalog Mix50/50 in a pump.
Who should not take Humalog, Humalog Mix75/25, or Humalog Mix50/50?
- Do not take these insulins if your blood sugar is too low (hypoglycemia) or if you are allergic to insulin lispro or any of the ingredients in these insulins
Before using Humalog, Humalog Mix75/25, or Humalog Mix50/50, what should I tell my healthcare providers?
- About all of your medical conditions, including liver, kidney, or heart problems.
- If you are pregnant or breastfeeding.
- About all medicines you take, including prescription (especially ones commonly called TZDs [thiazolidinediones]) and non-prescription medicines, vitamins, and herbal supplements.
How should I use Humalog, Humalog Mix75/25, or Humalog Mix50/50?
- These insulins start working faster than other insulins that contain regular human insulin. You should take Humalog within fifteen minutes before eating or right after eating a meal. You should take Humalog Mix75/25 and Humalog Mix50/50 within
fifteen minutes before eating.
- Always make sure that you receive the correct type of insulin from the pharmacy.
- Do not use Humalog if it is cloudy, colored, or has solid particles or clumps in it.
- Do not use Humalog Mix75/25 or Humalog Mix50/50 if they have solid particles or clumps in them. Humalog Mix75/25 and Humalog Mix50/50 should be mixed carefully before each use and should be cloudy or milky after mixing.
- Do not mix Humalog with insulin other than NPH when using a syringe. Do not mix or dilute Humalog when used in a pump.
- Never mix Humalog Mix75/25 or Humalog Mix50/50 in the same syringe with other insulin products. Never use Humalog Mix75/25 or Humalog Mix50/50 in a pump.
- Inject your insulin under your skin (subcutaneously). Never inject into a vein or muscle. Change (rotate) your injection site with each dose. Make sure you inject the correct insulin and dose.
- Depending on the type of diabetes you have, you may need to take Humalog with a longer-acting insulin or with oral antidiabetic medications.
- If you forget to take your insulin, your blood sugar may go too high (hyperglycemia), which can lead to serious problems such as loss of consciousness (passing out), coma, or even death.
- Your insulin dose may need to change because of illness, stress, other medicines you take, change in diet, or change in physical activity or exercise.
What are the possible side effects of Humalog, Humalog Mix75/25, or Humalog Mix50/50?
- Low blood sugar is the most common side effect. There are many causes of low blood sugar, including taking too much insulin. It is important to treat it quickly. You can treat mild to moderate low blood sugar by drinking or eating a quick
source of sugar right away. If severe, low blood sugar can cause unconsciousness (passing out), seizures, and death. Symptoms may be different for each person. Be sure to talk to your healthcare provider about low blood sugar symptoms and treatment.
- Severe life-threatening allergic reactions (whole-body reactions) can happen. Get medical help right away if you develop a rash over your whole body, have trouble breathing, have a fast heartbeat, or are sweating.
- Reactions at the injection site (local allergic reaction) such as redness, swelling, and itching can happen. If you keep having skin reactions or they are serious, talk to your healthcare provider. Do not inject insulin into a
skin area that is red, swollen, or itchy.
- Skin may thicken or pit at the injection site (lipodystrophy). Do not inject insulin into skin with these types of changes.
- Other side effects include low potassium in your blood (hypokalemia), and weight gain.
Serious side effects can include swelling of your hands and feet and heart failure when taking certain pills called thiazolidinediones or "TZDs" with Humalog, Humalog Mix75/25, or Humalog Mix50/50. This may occur in some people even if they have not had heart problems before. Tell your healthcare provider if you have shortness of breath, swelling of your ankles or feet, or sudden weight gain, which may be symptoms of heart failure. Your healthcare provider may need to adjust or stop your treatment with TZDs, Humalog, Humalog Mix75/25, or Humalog Mix50/50.
- These are not all of the possible side effects. Ask your healthcare providers for more information or for medical advice about side effects.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch
or call 1-800-FDA-1088.
Humalog, Humalog Mix75/25, and Humalog Mix50/50 are available by prescription only.
For additional information, talk to your healthcare providers and please click to access Full Prescribing Information for Humalog
, Humalog Mix75/25
, and Humalog Mix50/50
, and Patient Prescribing Information for Humalog
, Humalog Mix75/25
, and Humalog Mix50/50
Please see Instructions for Use that accompany your pen.
HI BOI CON ISI 31JAN2014
Humalog® and Humalog® KwikPen® are registered trademarks of Eli Lilly and Company and are available by prescription only.
Humalog® Mix75/25™, Humalog® Mix50/50™, Humalog® Mix75/25™ KwikPen®, and Humalog® Mix50/50™ KwikPen® are trademarks
of Eli Lilly and Company and are available by prescription only.