• BENICAR® can start lowering blood pressure in as little as 7 days. Eligible patients can try it FREE for 14 days.*

    Fill out the form below, click on the SUBMIT button, print out your voucher, then ask your doctor if a prescription is appropriate for you. See for yourself. *Terms and conditions apply.
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 I agree to receive communications from Daiichi Sankyo, Inc., maker of BENICAR and BENICAR HCT.

 I agree that Daiichi Sankyo, Inc. and companies working on its behalf can have access to information that I submit, as well as information obtained through my participation in the Right Fit Blood Pressure Program, in order to provide me with information that they believe may be of interest to me.

By clicking "Submit," I acknowledge that I understand that the information I submit pertaining to the Daiichi Sankyo voucher program may be used by companies working on behalf of Daiichi Sankyo, Inc. to administer this program.

TO THE PATIENT

It is illegal for any person to sell, purchase, or trade; or to offer to sell, purchase, or trade or to counterfeit this voucher. This voucher is valid for redemption at retail outpatient pharmacies only. This voucher must be accompanied by a valid prescription for BENICAR or BENICAR HCT. No purchase required. Product dispensed pursuant to terms of voucher shall not be submitted to any third-party payer, public (eg, Medicaid, Medicare, Veterans Administration, TRICARE/CHAMPUS or any other similar federal or state healthcare program) or private, for reimbursement. Not valid if reproduced or submitted to other payer. Offer good only in the United States. Offer cannot be combined with any other free trial, coupon, rebate, or similar offer. Daiichi Sankyo, Inc. reserves the right to rescind, revoke, or amend this voucher program without notice. Void where prohibited by law.

TO THE PHARMACIST

Please dispense 14 tablets of one of the following medications, as applicable: BENICAR 5 mg, BENICAR 20 mg, BENICAR 40 mg, BENICAR HCT 20/12.5 mg, BENICAR HCT 40/12.5 mg, or BENICAR HCT 40/25 mg when accompanied by a valid prescription at no co-pay or cost to the patient. Not to be used in lieu of patient co-payment for another prescription. This voucher is valid for BENICAR and BENICAR HCT sample use only–no substitutions permitted. Product dispensed pursuant to terms of card shall not be submitted to any third-party payer, public (eg, Medicaid, Medicare, Veterans Administration, TRICARE/CHAMPUS or any other similar federal or state healthcare program) or private, for reimbursement. Lifetime limit of one voucher per patient. Refills are not permitted with this voucher. Please remove this identification number from the patient profile after the claim is processed. For assistance in filing this claim, please call the Help Desk 1-800-657-7613. Product dispensed pursuant to terms of voucher shall only be submitted to McKesson for payment. Void where prohibited by law.

Helping to bring down your cost,

here's your
free trial
voucher

14 DAYS OF BENICAR

RxBIN: 610524 RxPCN: 1016 RxGRP: 40025646 ISSUER: (80840) ID: XXXXX

Eligible patients can present this voucher at the pharmacy together with a valid prescription for BENICAR or BENICAR HCT.

Pharmacist: Limit one TrialScript® voucher per patient. Redeem for product only when accompanied by a valid, signed prescription form for BENICAR or BENICAR HCT. Submit claim to McKesson Corporation using BIN #610524. For pharmacy processing questions, please call the Help Desk at 1-800-657-7613.

DSHN15101627  10/15