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To enroll in the Aptensio XR® Patient Access Support Program, please answer the following questions below:

Please complete all the items below.
In order to participate in the Aptensio XR® Patient Access Support Program and receive a benefit, you must meet certain eligibility criteria. Before you activate your card, it is important that you understand that you will be asked to provide personal information that may include your name, address, phone number, e-mail address, and information related to your insurance and treatment. This information is necessary to permit Rhodes, the manufacturer of Aptensio XR, and companies that work with Rhodes, including other vendors and affiliates, to provide benefits to you related to the activation and use of your Aptensio XR Copay Card. We may also use the information you give us, in a de-identified and aggregated form, to improve the Aptensio XR® Patient Access Support Program. The information you provide will be shared with companies supporting the program and as required by law. The information you provide will be governed by our site’s Privacy Policy.
This offer may not be combined with any other coupon, discount, prescription savings card, free trial, or any other offer. The selling, purchasing, trading, or counterfeiting of this card is prohibited. Offer only good in the United States. Rhodes reserves the right to rescind, revoke, or amend this offer without notice at any time.
By clicking on the Submit button below, you understand these terms and conditions and wish to participate in the Aptensio XR Patient Access Support Program.
      CANCEL

WE'RE SORRY.

Based on your answers, you are ineligible for the Aptensio XR® Patient Access Support Program.
If you have any questions about eligibility, please call Aptensio XR Support at 1-844-818-9045.

Please provide the following information:

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By enrolling in the Aptensio XR® Patient Access Support Program, you agree to allow the Aptensio XR® Patient Access Support Program to reach out to your insurance provider on your behalf to assist with the prior authorization process if necessary. The Aptensio XR® Patient Access Support Program will not sell or transfer your name, email address, or other information to any other party. The information may be aggregated with other information and sued to make improvements to the program.
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In order to participate in the Aptensio XR® Patient Access Support Program and receive a benefit, you must meet certain eligibility criteria. Before you activate your card, it is important that you understand that you will be asked to provide personal information that may include your name, address, phone number, e-mail address, and information related to your insurance and treatment. This information is necessary to permit Rhodes, the manufacturer of Aptensio XR®, and companies that work with Rhodes, including other vendors and affiliates, to provide benefits to you related to the activation and use of your Aptensio XR Copay Card. We may also use the information you give us, in a de-identified and aggregated form, to improve the Aptensio XR® Patient Access Support Program. The information you provide will be shared with companies supporting the program and as required by law. The information you provide will be governed by our site’s Privacy Policy.
Please complete all of the indicated mandatory fields to continue.
By clicking on the Submit button below, you understand these terms and conditions and wish to participate in the Aptensio XR® Patient Access Support Program.
      CANCEL

THANK YOU!

You can begin using this activated card immediately. Use your Aptensio XR® Copay Card to receive savings on your Aptensio XR® (methylphenidate HCl extended-release) prescription. If your pharmacy is unable to process your Aptensio XR Copay Card, you may still be eligible to receive a rebate. If you have any questions, please contact us at 1-844-818-9045.


Click here to go to www.AptensioXR.com.

THANK YOU!

To view and print your Aptensio XR® Copay card click on the button below.*


You can begin using this activated card immediately. Use your Aptensio XR Copay Card to receive savings on your Aptensio XR® (methylphenidate HCl extended-release) prescription. This offer may not be combined with any other coupon, discount, prescription savings card, free trial, or any other offer. The selling, purchasing, trading, or counterfeiting of this card is prohibited. Offer only good in the United States. Rhodes reserves the right to rescind, revoke, or amend this offer without notice at any time. Void where prohibited, taxed, or otherwise restricted by law. If you have any questions, please contact a support representative at 1-844-818-9045.

Click here to go to www.AptensioXR.com.

*Requires ADOBE® READER®.