This document provides details about a free trial offer for 3 pills of Viagra and a 30% discount on a future prescription. It outlines the terms and conditions of each offer. For the free trial, patients can redeem the voucher at a participating pharmacy with a valid prescription. It is only available to new patients and uninsured patients would submit one claim while insured patients would submit two. The 30% discount applies to the out of pocket costs up to $75 and is only for one use per person by December 31, 2013. Both offers require following specific instructions and cannot be combined with other offers.

1. FREE TRIAL3 FREE PILLS THIS TIME. 30% OFF NEXT TIME.
Patient: Redeem at retail pharmacy.
ToPharmacist:
• ForInsuredPatients: 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.
• ForUninsuredPatients: Submit claim to PDM under BIN: 610020.
• For help processing this card, call 1-866-562-6221.
3FREEPILLSTERMSANDCONDITIONS:
Byredeemingthisfreetrialvoucheryouacknowledgethatyoucurrentlymeettheeligibility
criteriaandcomplywiththetermsandconditionsdescribedbelow:
• You will receive 3 free VIAGRA pills.
• An original voucher and a valid prescription must be presented.
• Thevoucherwillbeacceptedonlyatparticipatingpharmacies.
• 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.
• This free trial voucher cannot be combined with any other rebate/coupon, free trial or similar offer
for the specified prescription.
• Thisfreetrialisnothealthinsurance.
• Offer good only in the U.S. and Puerto Rico.
• Only new patients may use this voucher. By redeeming this voucher, you certify that you are not
currently using VIAGRA.
• Only 1 voucher per person may be redeemed under this program.
• This voucher is not transferable.
• No membership fees.
• Pfizer reserves the right to rescind, revoke or amend this free trial voucher without notice.
• This free trial voucher expires 12/31/2013.
Patient: Redeem at retail pharmacy.
ToPharmacist:
• ForInsuredPatients: Process a coordination of benefits (COB/split bill) claim using patient’s
prescription insurance for the PRIMARY claim. Submit SECONDARY claim to PDM under BIN: 610020.
• ForUninsuredPatients: Submit claim to PDM under BIN: 610020.
• For help processing this card, call 1-866-562-6221.
30%OFFTERMSANDCONDITIONS:
Byusingthiscoupon(the“Card”),youacknowledgethatyoucurrentlymeettheeligibilitycriteria
andwillcomplywiththetermsandconditionsdescribedbelow:
• The Card is 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
(formerly known as “La Reforma de Salud”).
• The Card is 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.
• The Card is limited to 30% savings off of the amount of your co-pay or your out-of-pocket cost, with a
maximum savings of $75.00.
• You must deduct the value received under this program from any reimbursement request submitted
to your insurance plan, either directly by you or on your behalf.
• The Card cannot be combined with any other rebate/coupon, free trial or similar offer for the
specified prescription.
• TheCardwillbeacceptedonlyatparticipatingpharmacies.
• ThisCardisnothealthinsurance.
• Offer good only in the U.S. and Puerto Rico.
• The Card is limited to 1 per person during this offering period and is not transferable.
• Pfizer reserves the right to rescind, revoke or amend the program without notice.
• Offer expires 12/31/2013.
3 FREE PILLS
YOUR FIRST PRESCRIPTION
BIN:610020 Group#:99992184 ID#:
30% OFF
YOUR SECOND PRESCRIPTION
BIN:610020 Group#:99992185 ID#:
1
Print this page.
3
Take this page with your prescriptions
to the pharmacy to save on your
first 2 prescriptions.
2
See your doctor for
a prescription for VIAGRA.
This is not health insurance.
No membership fees. No membership fees.
This is not health insurance.
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
34197381406 34037136506