SIGN UP FOR INFO ON SAVINGS AND GEMTESA

Hoping to save some money on your prescription? Need to replace an expired Simple Savings Card? Want to hear the latest and greatest info on GEMTESA? Help us help you! Tell us a bit more about yourself, and let’s see what we can do together.

Please see Program Terms, Conditions, and Eligibility Criteria.

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Want to apply for a GEMTESA Simple Savings Card and/or get news and updates about GEMTESA?

You're way ahead! Let's apply to activate your offer.

Let's see what savings you're eligible for!

Do you have commercial prescription drug insurance?
(If you have Medicaid, Medicare, or other government-sponsored prescription insurance, such as VA/DOD, select “No”)
You must be at least 18 years old.
You must reside in the US or Puerto Rico.
Gender
Are you currently taking, or have you ever taken, medication for overactive bladder (OAB)?
Would you like to receive SMS communications?

By signing up, you certify that you are at least 18 years old and that you authorize GEMTESA and Sumitomo Pharma America to send you information, products, special offers, and partner communications. Also, you may unsubscribe from marketing communications sent by email at any time by clicking on the unsubscribe link in any email. The information you have provided will be used in a manner consistent with our Privacy Policy. Please read our Terms of Use.

I understand and consent to Sumitomo Pharma America to contact me using the information provided in this form, enrolling me, and for the proper operation, and administration of Sumitomo Pharma America’s patient support services and/or programs. I understand that Sumitomo Pharma America uses a business partner to provide me with updates, reminders, education, and other related products and services including conducting market research. We believe in your privacy and will not sell your information to any other companies.

By activating your card, you certify that the information provided above is true and correct and that you are not enrolled in a federal- or state-funded prescription drug benefit program, such as Medicare or Medicaid, or any private indemnity or HMO insurance plan that reimburses you for the entire cost of your prescription drugs. You also certify that you are not Medicare-eligible and enrolled in an employer-sponsored health plan or prescription drug benefit program for retirees. You further certify that should you begin receiving prescription benefits from one of these types of programs at any time, you will no longer participate in this savings program.

 

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