Savings & Support Unique IDSave With The Ozobax® Patient Savings Card Pay as little as $15 for 30 days* *Limitations apply. Reimbursement limited to $200 per month. Pharmacist and Beneficiary: When you use this card, you are certifying that you have not submitted and will not submit a claim for reimbursement under any Federal, State, or other Governmental program for this prescription. Patient Instructions: Get a valid prescription for OZOBAX (baclofen) Oral Solution 5mg/5mL by asking your doctor. Fill your prescription by taking your prescription and the Card to your pharmacy. Many eligible commercially insured patients may receive their prescription for up to $15.* *Program eligibility and restrictions apply. This offer is only valid for Ozobax, manufactured for Metacel Pharmaceuticals, LLC, or Baclofen Oral Solution 5mg/5mL, manufactured for Palmetto Pharmaceuticals Inc. No substitutions permitted. Void wherever prohibited by law, taxed, or restricted. Subject to the OFFER TERMS, CONDITIONS, AND PATIENT ELIGIBILITY REQUIREMENTS. Please see full prescribing information. Register and activate an OZOBAX Patient Savings Card. All fields are required. Name* First Last Email* Enter Email Confirm Email Metacel respects individual privacy and values the confidence of our customers. The information pertaining to you that we collect will be used in accordance with our Privacy Statement. By providing your email address, you agree and acknowledge that you would like to receive information from Metacel related to OZOBAX and the OZOBAX Patient Savings Card, including site updates, education, and other OZOBAX products and services. If you later wish to opt out from receiving this information, you may click on the included opt-out link in future communications.* I agree, and I certify that I am 18 years or older and the information I have provided above is true and correct. The “Copay Savings Card” constitutes an offer subject to the below “Offer Terms, Conditions, and Patient Eligibility Criteria.” This offer is not insurance. Quantity limits may apply.* I agree to the offer terms, conditions, and patient eligibility criteria outlined below. Each patient redeeming the Copay Savings Card acknowledges and agrees as follows: This offer is good for use only in regard to a patient’s valid prescription for Ozobax Oral Solution 5mg/5mL ("Ozobax”), manufactured for Metacel, or Baclofen Oral Solution 5mg/5mL ("Baclofen Oral Solution"), manufactured for Palmetto Pharmaceuticals Inc. ("Palmetto") when filled by a pharmacist at a participating pharmacy, and duly dispensed to the patient. No substitutions are permitted. Depending on insurance coverage, eligible patients may receive their prescription for Ozobax or Baclofen Oral Solution, manufactured for Metacel or Palmetto, for $15.00 or less. Each patient accepting this offer should ask the fulfilling pharmacist to determine any applicable copay discount. This offer is subject to a maximum of $200.00 to be applied to any copay obligation that a patient may have. Patient out-of-pocket expenses may vary. This offer is not valid for and may not be used by: patients enrolled in Medicare (including Part D), Medicaid, or other federal or state programs (including state pharmaceutical assistance programs, and for Puerto Rico, the Government Health Insurance Plan, formerly La Reforma de Salud, and for each any successor program); patients enrolled in private indemnity or HMO insurance plans or pharmacy benefit programs that in each instance reimburse the patient for the entire cost of a prescription drug; or patients who are Medicare-eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees. This offer is valid for those cash-paying patients not otherwise excluded by another provision of this offer. This offer is only good for the USA, including Puerto Rico, at participating pharmacies. This offer is void wherever prohibited by law, taxed, or restricted. The Copay Savings Card is not transferable. The selling, purchasing, trading, or counterfeiting of any Copay Savings Card is prohibited by law. The Copay Savings Card has no cash value and may not be used in combination with any other discount, coupon, rebate, free trial, or similar offer for the specified prescription. This offer is not health insurance. Each patient is responsible for applicable taxes, if any. Metacel Pharmaceuticals, LLC may rescind, revoke, or amend this offer at any time without notice. You are eligible for this offer, and understand its restrictions, terms, and conditions. If you have questions about the OZOBAX Patient Savings Card, please call 833-469-6229. NameThis field is for validation purposes and should be left unchanged.