Program Terms, Conditions, and Eligibility Criteria

This offer is valid only with a prescription for: DYANAVEL XR (amphetamine), QUILLIVANT XR (methylphenidate HCl), QUILLICHEW ER (methylphenidate HCl), and ONYDA XR (clonidine HCl) at the time the prescription is ﬁlled by the pharmacist and dispensed to the patient. This offer is valid only for patients within the age limitations and with the conditions described in the Prescribing Information for the dispensed Tris product. Maximum savings limits apply. Patient is responsible for costs above maximum savings limits. Out-of-pocket expense may vary. This offer is not valid for use by patients enrolled in Medicare, Medicaid, TriCare, Indian Health Service, Puerto Rico Government Health Insurance Plan, state pharmaceutical assistance programs, or any other federal or state health care or prescription drug beneﬁt program. Offer is restricted to residents of the United States and its Territories. Void where prohibited by law, taxed, or restricted. This card is not transferable. The selling, purchasing, trading, counterfeiting, or reproduction of this card is prohibited by law. This 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. Tris Pharma, Inc. reserves the right to rescind, revoke, or amend this offer without notice. By redeeming this card, you acknowledge that you are an eligible patient, that you understand and agree to comply with the terms and conditions of this offer, and that you will report the receipt of any beneﬁts under this offer if required by your health insurer.

If you have any questions about this offer, please call 1-872-351-5682.

Please see Full Prescribing Information for DYANAVEL XR, QUILLIVANT XR, QUILLICHEW ER, and ONYDA XR, including BOXED WARNING regarding ABUSE, MISUSE, and ADDICTION (for relevant products)