AZILECT Coupon Program

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Terms and Conditions

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Eligibility restriction, terms and conditions apply. See below for details.

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Eligibility Information

To activate and print your AZILECT coupon, we will need to ask you for personal information. It is important to provide accurate information. This information may be used by Opus Health ("Opus"), during the time that it acts as the paid administrator in connection with the AZILECT Coupon Program for the purposes of assessing eligibility under the Terms and Conditions of coupon use, activating the coupon (for eligible patients), and fraud verification.

Teva Neuroscience, Inc. understands that your privacy is important. Please note that by providing your name, address, or other information, you are giving Teva and companies working with us permission to communicate with you via traditional mail, email, telephone, or text about AZILECT. We will not sell or transfer your name, address, or other personally identifiable information about you to any party for its own marketing use.

I agree to the above statement.*

Are you 18 years of age or older?*

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

Are your prescriptions paid for in part or full by any state or federally funded programs, including but not limited to Medicare or Medicaid, Medigap, VA, DOD, TRICARE, CHAMPUS, or Puerto Rico Government Health insurance, or reimbursed in full (including co-pay) by any third party payer?*

If you begin receiving prescription benefits from any state, federal or government funded program at any time, you will no longer be eligible to participate in this program. Do you acknowledge agreement with this statement?*

Personal Information

Please complete the following form to sign up to receive a coupon for AZILECT.








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How long have you had Parkinson's Disease?

How long have you been taking AZILECT?

Program Rules - Patient Eligibility, Terms and Conditions:

Valid only for qualified patients with a valid prescription for AZILECT (rasagiline tablets). No substitutions permitted. This card is valid only for those with private insurance or cash-paying patients. This card is not valid for prescriptions paid for in part or in full by any state or federally funded program, including but not limited to, Medicare or Medicaid, Medigap, VA, DOD, Tricare, the Puerto Rico Government Health Insurance Plan or by private health insurance plans or by private health insurance plans or programs which reimburse you for the entire costs of your prescription drugs. This card is not valid for patients who are Medicare eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees (i.e., you are eligible for Medicare Part D but receive a prescription drug benefit through a former employer). Your discount with this card is valid to reduce your co-pay to $15 with a maximum benefit of $75 per prescription/refill. For example, if your total co-pay is $90 or less, you will pay no more than $15 per prescription/refill. If your co-pay is more than $90, your co-pay will be reduced by a maximum amount of $75 per prescription/refill. Discount is available on up to 12 prescription/refills for AZILECT. Offer expires 12/31/2013. Your acceptance of this offer must be consistent with the terms of any drug benefit provided by a health insurer, health plan, or other third-party payer, and you agree to report acceptance of this offer to your health insurer, health plan or third-party payer as may be required. Offer limited to one card per person and may not be used with any other discount, coupon or offer. Offer is not transferable. It is illegal to sell, purchase, trade or counterfeit this card. This card is not health insurance. This card is the property of Teva Neuroscience, Inc. and must be returned upon request. Offer valid only in the United States or the Commonwealth of Puerto Rico at participating pharmacies. Void in any state where prohibited by law, taxed, or restricted. Teva Neuroscience, Inc. reserves the right to change, rescind, revoke or discontinue this offer at any time without notice. By participating in this program, you the patient certify that (a) you have read the above terms; (b) you are not reimbursed, nor will you submit a claim for reimbursement, nor will you seek to have any portion of this prescription counted toward your out-of-pocket costs (e.g., TROOP) under any federal, state, or private programs for this or other prescriptions for AZILECT to which this offer will apply; and (c) you will otherwise comply with the terms above.

I have read and agree with these Terms and Conditions.*

I understand that the personal information that I provide will be kept  confidential and will not be shared with third-party processing agents  other than Teva Neuroscience, Inc. and its designated agents.*

I agree that the personal information provided above may be used by  Teva Neuroscience, its affiliates and their business partners to provide me with information about Parkinson's disease, related conditions and  products; and to develop products and services concerning Parkinson's disease which may include market research. I understand that I can  request my name and other personal information be removed from future contact at any time by visiting

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  • AZILECT® (rasagiline tablets) is indicated for the treatment of the signs and symptoms of Parkinson's disease (PD) both as initial therapy alone and to be added to levodopa later in the disease


  • Do not take AZILECT if you are taking meperidine as it could result in a serious reaction such as coma or death. Also, do not take AZILECT with tramadol, methadone, propoxyphene, dextromethorphan, St. John's wort, or cyclobenzaprine
  • You also should not take AZILECT with other monoamine oxidase inhibitors (MAOIs)
  • Inform your physician if you are taking, or planning to take, any prescription or over-the-counter drugs, especially antidepressants and ciprofloxacin
  • If you have moderate to severe liver disease, you should not take AZILECT
  • You should not exceed a dose of 1 mg per day of AZILECT in order to prevent a possibly dangerous increase in blood pressure. All PD patients should be monitored for melanoma (skin cancer) on a regular basis
  • Side effects seen with AZILECT alone are flu syndrome, joint pain, depression, and indigestion
  • When taken with levodopa are uncontrolled movements (dyskinesia), accidental injury, weight loss, low blood pressure when standing, vomiting, anorexia, joint pain, abdominal pain, nausea, constipation, dry mouth, rash, abnormal dreams, and fall
  • You are encouraged to report negative side effects of prescription drugs to the FDA. Visit, or call 1-800-FDA-1088