Start Saving Today with the
Xtampza® ER Co-pay Card!

PROGRAM TERMS, CONDITIONS, AND ELIGIBILITY CRITERIA

Offer is valid for commercially insured patients only. Most eligible commercially insured patients will pay as little as $35 (maximum benefit amount of $100) for each fill of Xtampza® ER (oxycodone) capsules. Any remaining out-of-pocket expense will be the patient’s responsibility. This offer is valid in the United States. Some restrictions may apply. Offer not valid for prescriptions reimbursed under Medicaid, a Medicare drug benefit plan, Tricare or other federal or state health programs (such as medical assistance programs). Cash Discount Cards and other non-insurance plans are not valid as primary under this offer. If the patient is eligible for drug benefits under any such program, the patient cannot use this offer. By using this offer, the patient certifies that he or she will comply with any terms of his or her health insurance contract requiring notification to his or her payer of the existence and/or value of this offer. This offer is not valid for cash paying patients. Offer not valid for patients under 18 years of age. Program is not valid in Massachusettsor in any other state or jurisdiction where prohibited or restricted by law.

Patient Instructions: To redeem this offer, you must have a valid prescription for Xtampza® ER and follow the dosage instructions provided by your healthcare provider with a valid Prescriber ID# (eg, NPI or DEA). This offer may not be redeemed for cash. Patients with questions about the Xtampza® ER savings offer should call 1-844-247-4753.

Pharmacist: When you apply this offer, you are certifying that you have not submitted a claim for reimbursement under any federal, state, or other governmental programs for this prescription. Participation in this program must comply with all applicable laws and regulations as a pharmacy provider.

Pharmacist instructions for a patient with an Eligible Third Party Payer: Submit the claim to the primary Third Party Payer first, then submit the balance due to Change Healthcare as a Secondary Payer COB [coordination of benefits] with patient responsibility amount and a valid Other Coverage Code (eg, 8). Most eligible commercially insured patients will pay as little as $35 (maximum benefit amount of $100) for Xtampza® ER capsules. Reimbursement will be received from Change Healthcare. Valid Other Coverage Code required. For any questions regarding Change Healthcare online processing, please call the Help Desk at 1-800-422-5604.

Program expires 06/30/2020.

This offer is not transferable and is limited to one offer per person. Not valid if reproduced. Void where prohibited by law. Program managed by ConnectiveRx on behalf of Collegium Pharmaceutical. The parties reserve the right to rescind, revoke or amend this offer without notice at any time.

Please see full Prescribing information, including Boxed Warning, and the Medication Guide at XtampzaER.com, or speak to your healthcare provider if you have questions about Xtampza ER.

INDICATIONS AND USAGE

Xtampza® ER (oxycodone) is:

IMPORTANT SAFETY INFORMATION ABOUT XTAMPZA ER

WARNING: ADDICTION, ABUSE, AND MISUSE; RISK EVALUATION AND MITIGATION STRATEGY (REMS); LIFE-THREATENING RESPIRATORY DEPRESSION; ACCIDENTAL INGESTION; NEONATAL OPIOID WITHDRAWAL SYNDROME; CYTOCHROME P450 3A4 INTERACTION; and RISKS FROM CONCOMITANT USE WITH BENZODIAZEPINES OR OTHER CNS DEPRESSANTS

Addiction, Abuse, and Misuse

Xtampza ER exposes patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death. Assess each patient’s risk prior to prescribing Xtampza ER and monitor all patients regularly for the development of these behaviors or conditions.

Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS)

To ensure that the benefits of opioid analgesics outweigh the risks of addiction, abuse, and misuse, the Food and Drug Administration (FDA) has required a REMS for these products. Under the requirements of the REMS, drug companies with approved opioid analgesic products must make REMS-compliant education programs available to healthcare providers. Healthcare providers are strongly encouraged to

Life-threatening Respiratory Depression

Serious, life-threatening, or fatal respiratory depression may occur with use of Xtampza ER. Monitor for respiratory depression, especially during initiation of Xtampza ER or following a dose increase.

Accidental Ingestion

Accidental ingestion of even one dose of Xtampza ER, especially by children, can result in a fatal overdose of oxycodone.

Neonatal Opioid Withdrawal Syndrome

Prolonged use of Xtampza ER during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening if not recognized and treated, and requires management according to protocols developed by neonatology experts. If opioid use is required for a prolonged period in a pregnant woman, advise the patient of the risk of neonatal opioid withdrawal syndrome and ensure that appropriate treatment will be available.

Cytochrome P450 3A4 Interaction

The concomitant use of Xtampza ER with all cytochrome P450 3A4 inhibitors may result in an increase in oxycodone plasma concentrations, which could increase or prolong adverse drug effects and may cause potentially fatal respiratory depression. In addition, discontinuation of a concomitantly used cytochrome P450 3A4 inducer may result in an increase in oxycodone plasma concentration. Monitor patients receiving Xtampza ER and any CYP3A4 inhibitor or inducer.

Risks From Concomitant Use With Benzodiazepines or Other CNS Depressants

Concomitant use of opioids with benzodiazepines or other central nervous system (CNS) depressants, including alcohol, may result in profound sedation, respiratory depression, coma, and death.

Important information about Xtampza ER:
Do not take Xtampza ER if you have:
Before taking Xtampza ER, tell your healthcare provider if you have a history of:
Tell your healthcare provider if you are:
When taking Xtampza ER:
While taking Xtampza ER, DO NOT:
The possible side effects of Xtampza ER are:
Get emergency medical help if you have:

These are not all the possible side effects of Xtampza ER. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088. For more information, go to dailymed.nlm.nih.gov

Please see full Prescribing information, including Boxed Warning, and the Medication Guide at XtampzaER.com, or speak to your healthcare provider if you have questions about Xtampza ER.

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