FREE TRIAL

3 FREE PILLS THIS TIME. 30% OFF NEXT TIME.

Print this page.

See your doctor for

a prescription for VIAGRA.

Take this page with your prescriptions

to the pharmacy to save on your
first 2 prescriptions.

3 FREE PILLS

30% OFF

YOUR FIRST PRESCRIPTION

YOUR SECOND PRESCRIPTION

$%/%/*+0$!(0$%*/1.*!

$%/%/*+0$!(0$%*/1.*!

BIN: 610020

Group#: 99992184

ID#: 99274545906

No membership fees.

BIN: 610020

Group#: 99992185

ID#: 99324529106

No membership fees.

Patient: Redeem at retail pharmacy.

To Pharmacist:
For Insured Patients: Submit claim for maximum of 3 pills to PDM using BIN: 610020. Your customer
will receive 3 pills at no charge. For pharmacy processing questions, please call the Help Desk at
1-866-562-6221.
For Uninsured Patients: Submit claim to PDM under BIN: 610020.
+.$!(,,.+!//%*#0$%/. ((

Patient: Redeem at retail pharmacy.

To Pharmacist:
For Insured Patients.+!//++. %*0%+*+"!*!0//,(%0%(((%)1/%*#,0%!*0/
prescription insurance for the PRIMARY claim. Submit 
 claim to PDM under BIN: 610020.
For Uninsured Patients: Submit claim to PDM under BIN: 610020.
+.$!(,,.+!//%*#0$%/. ((

3 FREE PILLS TERMS AND CONDITIONS:

By redeeming this free trial voucher you acknowledge that you currently meet the eligibility
criteria and comply with the terms and conditions described below:
You will receive 3 free VIAGRA pills.

30% OFF TERMS AND CONDITIONS:

*+.%#%*(2+1$!.* 2(% ,.!/.%,0%+*)1/0!,.!/!*0!

The voucher will be accepted only at participating pharmacies.
No claim for reimbursement for product dispensed pursuant to this voucher may be submitted
to any third party payor. Federal and state healthcare program beneficiaries are not eligible
for this voucher.
$%/".!!0.%(2+1$!.**+0!+)%*! 3%0$*5+0$!..!0!+1,+*".!!0.%(+./%)%(.+!.
for the specified prescription.
This free trial is not health insurance.
!.#++ +*(5%*0$!* 1!.0+%+
*(5*!3,0%!*0/)51/!0$%/2+1$!.5.! !!)%*#0$%/2+1$!.5+1!.0%"50$05+1.!*+0
currently using VIAGRA.
*(52+1$!.,!.,!./+*)5!.! !!)! 1* !.0$%/,.+#.)
$%/2+1$!.%/*+00.*/"!.(!
+)!)!./$%,"!!/
6!..!/!.2!/0$!.%#$00+.!/%* .!2+'!+.)!* 0$%/".!!0.%(2+1$!.3%0$+10*+0%!
$%/".!!0.%(2+1$!.!4,%.!/

By using this coupon (the Card), you acknowledge that you currently meet the eligibility criteria
and will comply with the terms and conditions described below:
$!. %/not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by
Medicaid, Medicare or other federal or state healthcare programs, including any state prescription
drug assistance programs and the Government Health Insurance Plan available in Puerto Rico
"+.)!.(5'*+3*/!"+.) !(1
$!. %/not valid for prescriptions that are eligible to be reimbursed by private insurance plans or
other health or pharmacy benefit programs which reimburse you for the entire cost of your
prescription drugs.
$!. %/(%)%0! 0+/2%*#/++"0$!)+1*0+"5+1.+,5+.5+1.+10+",+'!0+/03%0$
maximum savings of $75.00.
+1)1/0 ! 100$!2(1!.!!%2! 1* !.0$%/,.+#.)".+)*5.!%)1./!)!*0.!-1!/0/1)%00!
to your insurance plan, either directly by you or on your behalf.
$!. **+0!+)%*! 3%0$*5+0$!..!0!+1,+*".!!0.%(+./%)%(.+!."+.0$!
specified prescription.
The Card will be accepted only at participating pharmacies.
This Card is not health insurance.
!.#++ +*(5%*0$!* 1!.0+%+
$!. %/(%)%0! 0+,!.,!./+* 1.%*#0$%/+!.%*#,!.%+ * %/*+00.*/"!.(!
6!..!/!.2!/0$!.%#$00+.!/%* .!2+'!+.)!* 0$!,.+#.)3%0$+10*+0%!
!.!4,%.!/

The blue diamond tablet shape is a registered trademark of Pfizer Inc.

VGU489003-01

2012 Pfizer Inc.

All rights reserved.

September 2012

Pfizer, PO Box 29387, Mission, KS 66201-9618